- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $75.86 / $194.98
| Facility | | $8.13 | $75.86 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.08 / $22.91
| Professional | | $6.03 | $7.08 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $4.07 / $12.02
| Professional | | $3.63 | $4.07 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $10.96 / $10.96
| Professional | | $5.75 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $18.20 / $31.62
| Facility | | $5.25 | $18.20 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $6.17 / $12.30
| Professional | | $3.72 | $6.17 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $18.20 / $18.20
| Professional | | $7.24 | $18.20 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.82 / $5.50 / $8.13
| Facility | | $2.82 | $5.50 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $5.50 / $8.91
| Professional | | $3.39 | $5.50 | $8.91 |