- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.07 / $10.70 / $144.00
| Facility | | $6.07 | $10.70 | $144.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.65 / $4.20 / $5.83
| Professional | | $3.65 | $4.20 | $5.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.14 / $14.05 / $22.26
| Facility | | $5.14 | $14.05 | $22.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.04 / $4.20
| Professional | | $2.04 | $2.04 | $4.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.84 / $4.65 / $12.51
| Facility | | $2.84 | $4.65 | $12.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.97 / $4.45 / $7.23
| Professional | | $2.97 | $4.45 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.69 / $5.83 / $9.59
| Facility | | $3.69 | $5.83 | $9.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $6.32 / $17.93
| Professional | | $3.26 | $6.32 | $17.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.86 / $4.86 / $6.11
| Facility | | $4.86 | $4.86 | $6.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.80 / $4.86
| Professional | | $2.04 | $2.80 | $4.86 |