- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.48 / $14.04 / $54.00
| Facility | | $7.48 | $14.04 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $7.48 / $7.48
| Professional | | $3.80 | $7.48 | $7.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.48 / $5.48 / $5.48
| Facility | | $5.48 | $5.48 | $5.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.46 / $8.02 / $8.02
| Professional | | $5.46 | $8.02 | $8.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.05 / $5.05 / $5.05
| Facility | | $5.05 | $5.05 | $5.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $4.80
| Professional | | $3.13 | $3.13 | $4.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $5.94 / $12.00
| Facility | | $3.63 | $5.94 | $12.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.80 / $5.78 / $7.23
| Professional | | $2.80 | $5.78 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.82 / $4.82 / $4.82
| Facility | | $4.82 | $4.82 | $4.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.89 / $6.72
| Professional | | $2.02 | $2.89 | $6.72 |