- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.84 / $8.35 / $25.86
| Facility | | $2.84 | $8.35 | $25.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.22 / $2.87 / $6.00
| Professional | | $2.22 | $2.87 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $1.74 / $1.74
| Professional | | $1.74 | $1.74 | $1.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.29 / $7.11 / $10.31
| Facility | | $5.29 | $7.11 | $10.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $3.31 / $3.45
| Professional | | $3.31 | $3.31 | $3.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.76 / $2.38 / $4.50
| Facility | | $1.76 | $2.38 | $4.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.65 / $5.16
| Professional | | $1.70 | $2.65 | $5.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $2.87 / $100.00
| Facility | | $2.54 | $2.87 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.93 / $2.09 / $3.57
| Professional | | $1.93 | $2.09 | $3.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.87 / $1.75 / $10.11
| Facility | | $0.87 | $1.75 | $10.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.93 / $2.09 / $3.36
| Professional | | $1.93 | $2.09 | $3.36 |