- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.62 / $6.19 / $11.57
| Facility | | $3.62 | $6.19 | $11.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $3.57 / $4.15
| Professional | | $2.50 | $3.57 | $4.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.19 / $12.47 / $18.07
| Facility | | $9.19 | $12.47 | $18.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.58 / $4.58 / $4.82
| Professional | | $4.58 | $4.58 | $4.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.11 / $3.37 / $7.36
| Facility | | $3.11 | $3.37 | $7.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $4.51 / $7.23
| Professional | | $2.16 | $4.51 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.08 / $4.09 / $100.00
| Facility | | $4.08 | $4.09 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.60 / $6.03
| Professional | | $2.02 | $2.60 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $27.89
| Facility | | $19.50 | $19.50 | $27.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.41 / $3.13
| Professional | | $2.02 | $2.41 | $3.13 |