- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $9.46 / $31.50
| Facility | | $3.37 | $9.46 | $31.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.12 / $3.25 / $8.85
| Professional | | $3.12 | $3.25 | $8.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.18 / $7.18 / $7.18
| Facility | | $7.18 | $7.18 | $7.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $6.53 / $8.16
| Professional | | $4.13 | $6.53 | $8.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.43 / $5.74 / $100.00
| Facility | | $3.43 | $5.74 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $3.93 / $7.37
| Professional | | $2.15 | $3.93 | $7.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.62 / $7.30 / $11.22
| Facility | | $4.62 | $7.30 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.62 / $7.95 / $10.25
| Professional | | $4.62 | $7.95 | $10.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.84 / $8.36 / $9.83
| Professional | | $5.84 | $8.36 | $9.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $3.58 / $5.00
| Professional | | $2.15 | $3.58 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.58 / $3.58 / $3.58
| Professional | | $3.58 | $3.58 | $3.58 |