- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.78 / $1,181.00 / $3,109.00
| Facility | | $3.78 | $1,181.00 | $3,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $3.78 / $3.78
| Professional | | $2.37 | $3.78 | $3.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $3.38 / $3.75
| Professional | | $2.25 | $3.38 | $3.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.95 / $2.83 / $7.84
| Facility | | $1.95 | $2.83 | $7.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $9.38 / $11.72
| Professional | | $1.58 | $9.38 | $11.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.80 / $3.82
| Professional | | $1.26 | $1.80 | $3.82 |