- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.45 / $29.35 / $133.40
| Facility | | $7.45 | $29.35 | $133.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $5.77 / $11.28
| Professional | | $4.79 | $5.77 | $11.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $4.50 / $4.97
| Professional | | $3.24 | $4.50 | $4.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.62 / $13.09 / $23.67
| Facility | | $3.62 | $13.09 | $23.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $5.46 / $7.77
| Professional | | $3.75 | $5.46 | $7.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.55 / $10.53 / $18.95
| Facility | | $4.55 | $10.53 | $18.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.82 / $5.67 / $9.81
| Professional | | $3.82 | $5.67 | $9.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.86 / $5.66 / $100.00
| Facility | | $4.86 | $5.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.81 / $5.97
| Professional | | $2.72 | $3.81 | $5.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.81 / $5.18
| Professional | | $2.72 | $3.81 | $5.18 |