- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.25 / $7.00 / $63.48
| Facility | | $3.25 | $7.00 | $63.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.96 / $3.27 / $3.39
| Professional | | $2.96 | $3.27 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.41 / $16.66 / $24.14
| Facility | | $12.41 | $16.66 | $24.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $3.80 / $4.00
| Professional | | $3.80 | $3.80 | $4.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $2.80 / $5.98
| Facility | | $2.54 | $2.80 | $5.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $3.71 / $5.68
| Professional | | $1.73 | $3.71 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.32 / $3.32 / $80.00
| Facility | | $3.32 | $3.32 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $2.12 / $5.00
| Professional | | $1.68 | $2.12 | $5.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $15.85 / $15.85
| Facility | | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $2.06 / $4.00
| Professional | | $1.68 | $2.06 | $4.00 |