- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.08 / $6.08 / $6.08
| Facility | | $6.08 | $6.08 | $6.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $5.78 / $6.47
| Professional | | $4.84 | $5.78 | $6.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.47 / $33.85 / $76.48
| Facility | | $6.47 | $33.85 | $76.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $6.47 / $6.47
| Professional | | $5.18 | $6.47 | $6.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.19 / $23.89 / $57.47
| Facility | | $13.19 | $23.89 | $57.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.51 / $9.44 / $12.57
| Professional | | $7.51 | $9.44 | $12.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.06 / $21.84 / $45.25
| Facility | | $13.06 | $21.84 | $45.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.43 / $7.43 / $11.75
| Professional | | $7.43 | $7.43 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.47 / $13.11 / $100.00
| Facility | | $6.47 | $13.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $4.76 / $13.78
| Professional | | $2.72 | $4.76 | $13.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $4.76 / $5.05
| Facility | | $4.76 | $4.76 | $5.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $5.47 / $13.78
| Professional | | $2.72 | $5.47 | $13.78 |