- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $70.59 / $189.67
| Facility | | $15.14 | $70.59 | $189.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.02 / $7.56 / $11.06
| Professional | | $6.02 | $7.56 | $11.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.71 / $16.95 / $19.01
| Professional | | $12.71 | $16.95 | $19.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.50 / $9.59 / $12.06
| Professional | | $9.50 | $9.59 | $12.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.97 / $13.06 / $100.00
| Facility | | $5.97 | $13.06 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.21 / $10.09 / $16.82
| Professional | | $4.21 | $10.09 | $16.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $10.09 / $14.41
| Professional | | $3.53 | $10.09 | $14.41 |