- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.51 / $77.62 / $407.38
| Facility | | $8.51 | $77.62 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.48
| Professional | | $1.00 | $1.00 | $1.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.10 / $1.10
| Professional | | $1.07 | $1.10 | $1.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.02 / $1.10 / $1.10
| Facility | | $1.02 | $1.10 | $1.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.10 / $1.17
| Professional | | $1.10 | $1.10 | $1.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.07 / $1.10 / $5.01
| Facility | | $1.07 | $1.10 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.15 / $1.15
| Professional | | $1.10 | $1.15 | $1.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.38 / $1.86 / $2.00
| Facility | | $1.38 | $1.86 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.10 / $1.95
| Professional | | $1.10 | $1.10 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.10 / $1.10
| Professional | | $1.10 | $1.10 | $1.10 |