- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.42 / $94.23 / $143.63
| Facility | | $3.42 | $94.23 | $143.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.81 / $4.43 / $7.32
| Professional | | $3.81 | $4.43 | $7.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.18 / $22.01 / $44.26
| Facility | | $5.18 | $22.01 | $44.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $5.00 / $12.00
| Professional | | $2.00 | $5.00 | $12.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.59 / $14.14 / $29.63
| Facility | | $2.59 | $14.14 | $29.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $3.11 / $7.23
| Professional | | $2.47 | $3.11 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.81 / $5.36 / $9.10
| Facility | | $3.81 | $5.36 | $9.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $6.72 / $9.00
| Professional | | $5.00 | $6.72 | $9.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $2.68 / $3.86
| Professional | | $2.68 | $2.68 | $3.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.93 / $8.77
| Professional | | $2.04 | $2.93 | $8.77 |