- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.48 / $10.02 / $17.52
| Facility | | $5.48 | $10.02 | $17.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $5.40 / $5.48
| Professional | | $5.40 | $5.40 | $5.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.75 / $5.09 / $11.92
| Facility | | $4.75 | $5.09 | $11.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $7.42 / $10.84
| Professional | | $3.31 | $7.42 | $10.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.03 / $7.90 / $100.00
| Facility | | $7.03 | $7.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $4.17 / $9.64
| Professional | | $3.07 | $4.17 | $9.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.54 / $31.54 / $45.10
| Facility | | $31.54 | $31.54 | $45.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $3.65 / $4.75
| Professional | | $3.07 | $3.65 | $4.75 |