- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.28 / $82.10 / $603.91
| Facility | | $6.28 | $82.10 | $603.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $3.39 / $137.54
| Professional | | $3.07 | $3.39 | $137.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.00 / $28.75 / $71.50
| Facility | | $11.00 | $28.75 | $71.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $5.00 / $12.00
| Professional | | $3.14 | $5.00 | $12.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.13 / $11.37 / $31.88
| Facility | | $7.13 | $11.37 | $31.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $2.47 / $5.68
| Professional | | $1.97 | $2.47 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $4.51 / $7.67
| Facility | | $3.07 | $4.51 | $7.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $5.62 / $8.00
| Professional | | $4.00 | $5.62 | $8.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $2.16 / $3.11
| Professional | | $2.16 | $2.16 | $3.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $3.86 / $5.73
| Professional | | $2.36 | $3.86 | $5.73 |