- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.92 / $7.02 / $46.98
| Facility | | $1.92 | $7.02 | $46.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.14 / $4.55
| Professional | | $2.06 | $2.14 | $4.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.19 / $1.19 / $1.42
| Professional | | $1.19 | $1.19 | $1.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.47 / $23.46 / $33.97
| Facility | | $17.47 | $23.46 | $33.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $2.42
| Professional | | $2.25 | $2.25 | $2.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.54 / $1.65 / $3.87
| Facility | | $1.54 | $1.65 | $3.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.39 / $2.39 / $3.10
| Professional | | $1.39 | $2.39 | $3.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.14 / $2.37 / $100.00
| Facility | | $2.14 | $2.37 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $1.58 / $3.32
| Professional | | $1.42 | $1.58 | $3.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $1.58 / $2.37
| Professional | | $1.42 | $1.58 | $2.37 |