- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.40 / $50.76 / $51.66
| Facility | | $5.40 | $50.76 | $51.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.50 / $6.94 / $13.96
| Professional | | $4.50 | $6.94 | $13.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.61 / $15.54 / $17.35
| Professional | | $11.61 | $15.54 | $17.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $9.18 / $11.54
| Professional | | $9.09 | $9.18 | $11.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.40 / $11.57 / $100.00
| Facility | | $5.40 | $11.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.86 / $9.25 / $15.42
| Professional | | $3.86 | $9.25 | $15.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $8.48 / $13.21
| Professional | | $3.24 | $8.48 | $13.21 |