- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $35.48 / $100.00
| Facility | | $3.47 | $35.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.69 / $3.31
| Professional | | $2.00 | $2.69 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $2.09 / $3.98
| Professional | | $1.51 | $2.09 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.89 / $7.08 / $9.55
| Facility | | $5.89 | $7.08 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.19 / $3.02
| Professional | | $2.04 | $2.19 | $3.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $3.16 / $6.46
| Facility | | $2.34 | $3.16 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $2.29 / $16.60
| Professional | | $1.48 | $2.29 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.78 / $3.02 / $41.69
| Facility | | $1.78 | $3.02 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.74 / $5.25
| Professional | | $1.26 | $1.74 | $5.25 |