- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.56 / $29.04 / $61.74
| Facility | | $3.56 | $29.04 | $61.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $3.16 / $15.00
| Professional | | $1.82 | $3.16 | $15.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $3.92 / $4.90
| Professional | | $2.50 | $3.92 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $4.15 / $11.41
| Professional | | $2.37 | $4.15 | $11.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $4.22 / $33.20
| Facility | | $2.37 | $4.22 | $33.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $3.08 / $5.96
| Professional | | $2.37 | $3.08 | $5.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.91 / $4.83 / $7.43
| Facility | | $2.91 | $4.83 | $7.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.85 / $4.83 / $6.19
| Professional | | $2.85 | $4.83 | $6.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $5.19
| Professional | | $2.37 | $2.37 | $5.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.87 / $2.37 / $2.37
| Professional | | $1.87 | $2.37 | $2.37 |