- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.96 / $9.21 / $54.01
| Facility | | $2.96 | $9.21 | $54.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.17 / $3.47 / $4.74
| Professional | | $2.17 | $3.47 | $4.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $2.37
| Professional | | $2.37 | $2.37 | $2.37 |
- 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
- $3.75 / $3.75 / $4.04
| Professional | | $3.75 | $3.75 | $4.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $2.76 / $6.45
| Facility | | $2.57 | $2.76 | $6.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.33 / $3.98 / $5.68
| Professional | | $2.33 | $3.98 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.57 / $3.80 / $100.00
| Facility | | $3.57 | $3.80 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $2.25 / $4.94
| Professional | | $1.66 | $2.25 | $4.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $1.98 / $2.57
| Professional | | $1.66 | $1.98 | $2.57 |