- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.61 / $85.02 / $124.38
| Facility | | $39.61 | $85.02 | $124.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $4.68 / $6.19
| Professional | | $3.63 | $4.68 | $6.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $10.44 / $11.72
| Professional | | $7.83 | $10.44 | $11.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $5.84 / $7.34
| Professional | | $5.78 | $5.84 | $7.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $8.01 / $100.00
| Facility | | $3.63 | $8.01 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $6.22 / $8.88
| Professional | | $2.57 | $6.22 | $8.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.18 / $3.62 / $8.88
| Professional | | $2.18 | $3.62 | $8.88 |