- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $22.44 / $62.37
| Facility | | $3.02 | $22.44 | $62.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $2.82 / $14.82
| Professional | | $2.82 | $2.82 | $14.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.09 / $36.65 / $71.47
| Facility | | $28.09 | $36.65 | $71.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.25 / $6.49 / $7.00
| Professional | | $3.25 | $6.49 | $7.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.50 / $5.12 / $6.62
| Professional | | $4.50 | $5.12 | $6.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.56 / $11.18 / $85.00
| Facility | | $2.56 | $11.18 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $4.26 / $12.00
| Professional | | $2.56 | $4.26 | $12.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.13 / $6.48 / $9.27
| Facility | | $5.13 | $6.48 | $9.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $8.55 / $13.30
| Professional | | $5.13 | $8.55 | $13.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $4.26 / $8.53
| Professional | | $2.56 | $4.26 | $8.53 |