- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.97 / $191.60 / $212.48
| Facility | | $6.97 | $191.60 | $212.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $3.21 / $4.04
| Professional | | $3.07 | $3.21 | $4.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.20 / $2.20 / $2.20
| Professional | | $2.20 | $2.20 | $2.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.63 / $3.67 / $4.59
| Facility | | $1.63 | $3.67 | $4.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $2.22 / $2.81
| Professional | | $1.81 | $2.22 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $4.30 / $13.31
| Facility | | $2.39 | $4.30 | $13.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $4.13 / $5.16
| Professional | | $2.70 | $4.13 | $5.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $3.67 / $3.85
| Professional | | $0.06 | $3.67 | $3.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.26 / $1.26
| Professional | | $1.26 | $1.26 | $1.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $3.67 / $30.00
| Professional | | $1.54 | $3.67 | $30.00 |