- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.33 / $85.54 / $148.02
| Facility | | $3.33 | $85.54 | $148.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.33 / $3.87 / $6.04
| Professional | | $3.33 | $3.87 | $6.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.93 / $27.88 / $49.30
| Facility | | $9.93 | $27.88 | $49.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.26 / $5.14 / $12.50
| Professional | | $4.26 | $5.14 | $12.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.77 / $12.40 / $34.00
| Facility | | $7.77 | $12.40 | $34.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $2.72 / $6.20
| Professional | | $2.14 | $2.72 | $6.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.33 / $4.93 / $8.44
| Facility | | $3.33 | $4.93 | $8.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $6.11 / $8.00
| Professional | | $5.00 | $6.11 | $8.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.35 / $2.35 / $3.38
| Professional | | $2.35 | $2.35 | $3.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $4.21 / $5.96
| Professional | | $2.56 | $4.21 | $5.96 |