- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.24 / $22.64 / $92.02
| Facility | | $3.24 | $22.64 | $92.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.78 / $2.00 / $3.70
| Professional | | $1.78 | $2.00 | $3.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.12 / $5.51
| Professional | | $1.12 | $1.12 | $5.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.24 / $2.49 / $3.06
| Professional | | $1.24 | $2.49 | $3.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.46 / $4.72 / $9.02
| Facility | | $1.46 | $4.72 | $9.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.04 / $1.88 / $3.91
| Professional | | $1.04 | $1.88 | $3.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.75 / $60.00 / $60.00
| Facility | | $5.75 | $60.00 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $3.67 / $5.05
| Professional | | $2.02 | $3.67 | $5.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.35 / $2.24 / $2.25
| Facility | | $1.35 | $2.24 | $2.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.01 / $2.25 / $3.14
| Professional | | $1.01 | $2.25 | $3.14 |