- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.92 / $16.07 / $63.41
| Facility | | $4.92 | $16.07 | $63.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.21 / $3.93 / $11.21
| Professional | | $3.21 | $3.93 | $11.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $3.03 / $3.05
| Professional | | $1.58 | $3.03 | $3.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.43 / $9.55 / $15.91
| Facility | | $2.43 | $9.55 | $15.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $3.66 / $5.22
| Professional | | $2.52 | $3.66 | $5.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $7.08 / $12.74
| Facility | | $3.07 | $7.08 | $12.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $4.96 / $6.71
| Professional | | $2.48 | $4.96 | $6.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.26 / $3.95 / $100.00
| Facility | | $3.26 | $3.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.83 / $2.54 / $3.93
| Professional | | $1.83 | $2.54 | $3.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.83 / $2.54 / $3.48
| Professional | | $1.83 | $2.54 | $3.48 |