- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.33 / $17.30 / $91.19
| Facility | | $4.33 | $17.30 | $91.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.33 / $6.92 / $37.10
| Professional | | $4.33 | $6.92 | $37.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.38 / $38.20 / $62.02
| Facility | | $10.38 | $38.20 | $62.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $4.72 / $5.42
| Professional | | $3.54 | $4.72 | $5.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.75 / $3.75 / $3.75
| Facility | | $3.75 | $3.75 | $3.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.58 / $6.61 / $10.85
| Professional | | $3.58 | $6.61 | $10.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.17 / $3.17 / $3.17
| Professional | | $3.17 | $3.17 | $3.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.14 / $6.92 / $11.30
| Facility | | $5.14 | $6.92 | $11.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $5.77 / $10.85
| Professional | | $5.77 | $5.77 | $10.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $3.41 / $3.54
| Professional | | $2.42 | $3.41 | $3.54 |