- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.08 / $25.74 / $63.29
| Facility | | $3.08 | $25.74 | $63.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $3.28 / $4.04
| Professional | | $1.95 | $3.28 | $4.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.20 / $2.20 / $2.54
| Professional | | $2.20 | $2.20 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.41 / $16.66 / $24.14
| Facility | | $12.41 | $16.66 | $24.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.49 / $3.49 / $3.75
| Professional | | $3.49 | $3.49 | $3.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $2.56 / $5.98
| Facility | | $2.39 | $2.56 | $5.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.59 / $3.71 / $5.16
| Professional | | $1.59 | $3.71 | $5.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.32 / $3.32 / $100.00
| Facility | | $3.32 | $3.32 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $2.10 / $4.59
| Professional | | $1.54 | $2.10 | $4.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $1.77 / $2.39
| Professional | | $1.54 | $1.77 | $2.39 |