- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $17.00 / $57.24
| Facility | | $3.20 | $17.00 | $57.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $3.10 / $4.26
| Professional | | $2.62 | $3.10 | $4.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.56 / $2.56
| Professional | | $2.56 | $2.56 | $2.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.47 / $23.46 / $33.97
| Facility | | $17.47 | $23.46 | $33.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.05 / $4.05 / $4.05
| Professional | | $4.05 | $4.05 | $4.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.46 / $2.98 / $5.81
| Facility | | $2.46 | $2.98 | $5.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $3.45 / $6.20
| Professional | | $2.15 | $3.45 | $6.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.11 / $3.63 / $100.00
| Facility | | $3.11 | $3.63 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.65 / $5.08
| Professional | | $2.56 | $2.65 | $5.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.56 / $4.26
| Professional | | $2.56 | $2.56 | $4.26 |