- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.91 / $28.84 / $58.88
| Facility | | $1.91 | $28.84 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $2.14 / $9.77
| Professional | | $1.00 | $2.14 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.48 / $3.55
| Professional | | $1.20 | $1.48 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $3.24 / $3.24
| Professional | | $1.70 | $3.24 | $3.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.55 / $5.50 / $9.12
| Facility | | $1.55 | $5.50 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.05 / $1.82 / $3.63
| Professional | | $1.05 | $1.82 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $100.00
| Facility | | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $5.37 / $5.37
| Professional | | $2.14 | $5.37 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.85 / $2.00 / $2.34
| Facility | | $0.85 | $2.00 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $2.34 / $3.31
| Professional | | $1.41 | $2.34 | $3.31 |