- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $10.72 / $70.79
| Facility | | $7.41 | $10.72 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $15.14
| Professional | | $3.98 | $5.01 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Professional | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.17 / $6.17 / $21.38
| Facility | | $6.17 | $6.17 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.82 / $5.50 / $15.49
| Professional | | $2.82 | $5.50 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $11.48 / $12.88
| Facility | | $10.72 | $11.48 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $11.48 / $32.36
| Facility | | $7.41 | $11.48 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $6.31 / $8.32
| Professional | | $3.31 | $6.31 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $10.72 / $100.00
| Facility | | $5.37 | $10.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $3.72 / $7.41
| Professional | | $2.57 | $3.72 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.24 / $6.17 / $7.41
| Facility | | $3.24 | $6.17 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $3.72 / $7.41
| Professional | | $2.57 | $3.72 | $7.41 |