- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.58 / $142.33 / $291.30
| Facility | | $6.58 | $142.33 | $291.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.35 / $56.32
| Professional | | $3.02 | $3.35 | $56.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.88 / $4.49 / $5.04
| Facility | | $3.88 | $4.49 | $5.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.40 / $4.25
| Professional | | $2.72 | $3.40 | $4.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.32 / $4.09 / $4.30
| Professional | | $3.32 | $4.09 | $4.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.02 / $3.02
| Professional | | $3.02 | $3.02 | $3.02 |