- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.35 / $12.32 / $72.90
| Facility | | $3.35 | $12.32 | $72.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.39 / $3.31 / $11.21
| Professional | | $2.39 | $3.31 | $11.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.22 / $2.54 / $2.81
| Professional | | $1.22 | $2.54 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.04 / $7.55 / $13.40
| Facility | | $2.04 | $7.55 | $13.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $3.09 / $4.40
| Professional | | $2.12 | $3.09 | $4.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $5.98 / $10.76
| Facility | | $2.57 | $5.98 | $10.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $4.54 / $5.68
| Professional | | $2.50 | $4.54 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.94 / $3.32 / $100.00
| Facility | | $2.94 | $3.32 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $2.15 / $2.94
| Professional | | $1.54 | $2.15 | $2.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $2.15 / $3.38
| Professional | | $1.54 | $2.15 | $3.38 |