- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.51 / $6.10 / $77.50
| Facility | | $4.51 | $6.10 | $77.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.36 / $4.51 / $2,256.44
| Professional | | $3.36 | $4.51 | $2,256.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $2.62 / $2.73
| Professional | | $2.62 | $2.62 | $2.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.50 / $7.88 / $10.61
| Facility | | $6.50 | $7.88 | $10.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $2.87 / $4.01
| Professional | | $2.73 | $2.87 | $4.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $4.13 / $12.32
| Facility | | $3.07 | $4.13 | $12.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $3.02 / $5.68
| Professional | | $2.04 | $3.02 | $5.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $2.36 / $5.00
| Professional | | $2.36 | $2.36 | $5.00 |