- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.67 / $9.67 / $72.00
| Facility | | $7.67 | $9.67 | $72.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $7.03 / $7.68
| Professional | | $6.76 | $7.03 | $7.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.23 / $3.23 / $3.23
| Professional | | $3.23 | $3.23 | $3.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.60 / $9.47 / $16.05
| Facility | | $6.60 | $9.47 | $16.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $6.06 / $8.18
| Professional | | $4.12 | $6.06 | $8.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.06 / $8.08 / $21.92
| Facility | | $6.06 | $8.08 | $21.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $5.25 / $8.08
| Professional | | $5.25 | $5.25 | $8.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.22 / $9.50 / $11.87
| Professional | | $6.22 | $9.50 | $11.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.67 / $10.76 / $77.62
| Facility | | $7.67 | $10.76 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.93 / $9.60 / $11.29
| Professional | | $6.93 | $9.60 | $11.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.02 / $6.69 / $9.03
| Professional | | $6.02 | $6.69 | $9.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $5.17 / $7.02
| Professional | | $3.39 | $5.17 | $7.02 |