- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.21 / $15.65 / $32.65
| Facility | | $10.21 | $15.65 | $32.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $10.07 / $10.21
| Professional | | $10.07 | $10.07 | $10.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.88 / $9.51 / $18.61
| Facility | | $7.88 | $9.51 | $18.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $11.40 / $19.62
| Professional | | $6.05 | $11.40 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.57 / $14.72 / $100.00
| Facility | | $11.57 | $14.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $6.68 / $15.91
| Professional | | $5.72 | $6.68 | $15.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $6.55 / $8.85
| Professional | | $5.72 | $6.55 | $8.85 |