- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.26 / $15.83 / $63.00
| Facility | | $5.26 | $15.83 | $63.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.87 / $5.16 / $5.24
| Professional | | $3.87 | $5.16 | $5.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $4.01 / $4.42
| Professional | | $3.75 | $4.01 | $4.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.23 / $12.69 / $21.15
| Facility | | $3.23 | $12.69 | $21.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $4.86 / $6.93
| Professional | | $3.34 | $4.86 | $6.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.05 / $9.38 / $16.88
| Facility | | $4.05 | $9.38 | $16.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.83 / $7.02 / $8.77
| Professional | | $3.83 | $7.02 | $8.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.62 / $5.23 / $100.00
| Facility | | $4.62 | $5.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $3.39 / $4.71
| Professional | | $2.42 | $3.39 | $4.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $3.39 / $3.54
| Professional | | $2.42 | $3.39 | $3.54 |