- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.16 / $64.58 / $91.87
| Facility | | $6.16 | $64.58 | $91.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $5.78 / $7.62
| Professional | | $5.56 | $5.78 | $7.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $3.98 / $4.59
| Professional | | $3.98 | $3.98 | $4.59 |
- 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
- $6.30 / $6.30 / $6.77
| Professional | | $6.30 | $6.30 | $6.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.30 / $4.63 / $10.83
| Facility | | $4.30 | $4.63 | $10.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.88 / $6.63 / $9.28
| Professional | | $2.88 | $6.63 | $9.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.78 / $6.63 / $100.00
| Facility | | $5.78 | $6.63 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.78 / $3.82 / $8.28
| Professional | | $2.78 | $3.82 | $8.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.27 / $5.97 / $9.05
| Facility | | $3.27 | $5.97 | $9.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.78 / $3.32 / $4.30
| Professional | | $2.78 | $3.32 | $4.30 |