- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.41 / $60.63 / $128.97
| Facility | | $8.41 | $60.63 | $128.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $5.63 / $7.76
| Professional | | $4.84 | $5.63 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.22 / $10.22 / $10.22
| Professional | | $10.22 | $10.22 | $10.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.47 / $6.79 / $29.87
| Facility | | $6.47 | $6.79 | $29.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.19 / $7.44 / $17.41
| Professional | | $3.19 | $7.44 | $17.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.61 / $13.59 / $36.47
| Facility | | $8.61 | $13.59 | $36.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.81 / $6.67 / $9.68
| Professional | | $3.81 | $6.67 | $9.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.24 / $11.71 / $100.00
| Facility | | $5.24 | $11.71 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $4.61 / $8.11
| Professional | | $2.72 | $4.61 | $8.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $5.42 / $8.39
| Professional | | $2.72 | $5.42 | $8.39 |