- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.96 / $22.18 / $143.00
| Facility | | $3.96 | $22.18 | $143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $3.31 / $4.28
| Professional | | $2.75 | $3.31 | $4.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.20 / $2.20 / $2.54
| Professional | | $2.20 | $2.20 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.48 / $3.95 / $11.04
| Facility | | $2.48 | $3.95 | $11.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $4.13 / $5.68
| Professional | | $2.47 | $4.13 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.64 / $20.84 / $33.59
| Facility | | $3.64 | $20.84 | $33.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $5.07 / $6.03
| Professional | | $1.81 | $5.07 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.90 / $2.09 / $2.61
| Professional | | $1.90 | $2.09 | $2.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.28 / $2.15 / $5.12
| Professional | | $1.28 | $2.15 | $5.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.90 / $2.38 / $2.38
| Professional | | $1.90 | $2.38 | $2.38 |