- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.48 / $75.00 / $145.35
| Facility | | $4.48 | $75.00 | $145.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.27 / $4.28
| Professional | | $3.02 | $3.27 | $4.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.20 / $2.40 / $2.81
| Professional | | $2.20 | $2.40 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $3.95 / $12.04
| Facility | | $2.54 | $3.95 | $12.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $4.54 / $6.20
| Professional | | $2.47 | $4.54 | $6.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.62 / $2.62 / $3.79
| Facility | | $2.62 | $2.62 | $3.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $5.12 / $6.03
| Professional | | $1.97 | $5.12 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.92 / $2.11 / $2.64
| Professional | | $1.92 | $2.11 | $2.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.60 / $4.00 / $6.00
| Facility | | $3.60 | $4.00 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $2.15 / $5.38
| Professional | | $1.60 | $2.15 | $5.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.40 / $2.40
| Professional | | $2.06 | $2.40 | $2.40 |