- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.82 / $18.07 / $49.71
| Facility | | $2.82 | $18.07 | $49.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.14 / $4.00
| Professional | | $2.06 | $2.14 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $3.75 / $3.75
| Professional | | $3.75 | $3.75 | $3.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $2.49 / $10.94
| Facility | | $2.37 | $2.49 | $10.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.17 / $2.21 / $6.38
| Professional | | $1.17 | $2.21 | $6.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.19 / $4.97 / $13.12
| Facility | | $3.19 | $4.97 | $13.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $2.46 / $3.39
| Professional | | $1.37 | $2.46 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $3.99 / $100.00
| Facility | | $2.13 | $3.99 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $2.37 / $3.54
| Professional | | $1.42 | $2.37 | $3.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.19 / $2.37 / $3.62
| Professional | | $1.19 | $2.37 | $3.62 |