- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.58 / $16.00 / $77.70
| Facility | | $3.58 | $16.00 | $77.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.63 / $3.93 / $27.00
| Professional | | $2.63 | $3.93 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.54
| Professional | | $2.54 | $2.54 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.20 / $7.85 / $14.37
| Facility | | $2.20 | $7.85 | $14.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $3.31 / $4.72
| Professional | | $2.27 | $3.31 | $4.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.74 / $6.38 / $11.48
| Facility | | $2.74 | $6.38 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $4.54 / $6.20
| Professional | | $2.54 | $4.54 | $6.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.14 / $3.41 / $62.00
| Facility | | $3.14 | $3.41 | $62.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $3.29 / $4.16
| Professional | | $2.36 | $3.29 | $4.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $3.29 / $3.93
| Professional | | $2.36 | $3.29 | $3.93 |