- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.51 / $15.43 / $66.43
| Facility | | $5.51 | $15.43 | $66.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.68 / $6.06 / $11.64
| Professional | | $5.68 | $6.06 | $11.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $4.63 / $4.63
| Professional | | $4.63 | $4.63 | $4.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.52 / $24.87 / $36.04
| Facility | | $18.52 | $24.87 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.35 / $6.35 / $6.67
| Professional | | $6.35 | $6.35 | $6.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.34 / $4.67 / $10.66
| Facility | | $4.34 | $4.67 | $10.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.03 / $6.63 / $9.81
| Professional | | $3.03 | $6.63 | $9.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.68 / $6.06 / $100.00
| Facility | | $5.68 | $6.06 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $3.73 / $8.35
| Professional | | $2.81 | $3.73 | $8.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $3.44 / $6.68
| Professional | | $2.81 | $3.44 | $6.68 |