- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.07 / $35.71 / $95.82
| Facility | | $8.07 | $35.71 | $95.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $1.90 / $13.36
| Professional | | $1.81 | $1.90 | $13.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.29
| Professional | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.83 / $3.51 / $18.43
| Facility | | $2.83 | $3.51 | $18.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $4.24 / $5.88
| Professional | | $1.81 | $4.24 | $5.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.71 / $1.71 / $1.81
| Facility | | $1.71 | $1.71 | $1.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $1.81 / $2.29
| Professional | | $1.81 | $1.81 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.79 / $4.11 / $10.00
| Facility | | $1.79 | $4.11 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $4.65 / $10.00
| Professional | | $3.00 | $4.65 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $3.80 / $10.56
| Professional | | $1.97 | $3.80 | $10.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $1.92 / $2.02
| Professional | | $1.54 | $1.92 | $2.02 |