- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.08 / $18.41 / $118.80
| Facility | | $6.08 | $18.41 | $118.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.87 / $4.96 / $27.52
| Professional | | $2.87 | $4.96 | $27.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $8.93 / $15.65
| Facility | | $2.39 | $8.93 | $15.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $3.61 / $5.14
| Professional | | $2.48 | $3.61 | $5.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.99 / $6.95 / $12.51
| Facility | | $2.99 | $6.95 | $12.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.83 / $5.37 / $6.71
| Professional | | $2.83 | $5.37 | $6.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.21 / $3.86 / $100.00
| Facility | | $3.21 | $3.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.80 / $2.50 / $3.92
| Professional | | $1.80 | $2.50 | $3.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.85 / $5.14 / $5.36
| Facility | | $3.85 | $5.14 | $5.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.80 / $2.50 / $3.42
| Professional | | $1.80 | $2.50 | $3.42 |