- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $10.23 / $11.75
| Facility | | $5.01 | $10.23 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $10.23
| Professional | | $3.98 | $5.01 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $6.03 / $21.38
| Facility | | $6.03 | $6.03 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $4.68 / $14.45
| Professional | | $2.45 | $4.68 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $9.77 / $11.48
| Facility | | $9.55 | $9.77 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.76 / $11.48 / $27.54
| Facility | | $6.76 | $11.48 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.88 / $6.03 / $8.32
| Professional | | $2.88 | $6.03 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $10.47 / $100.00
| Facility | | $5.25 | $10.47 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.51 / $3.63 / $6.92
| Professional | | $2.51 | $3.63 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.88 / $6.03 / $7.24
| Facility | | $2.88 | $6.03 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.51 / $3.63 / $7.24
| Professional | | $2.51 | $3.63 | $7.24 |