- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $7.76 / $10.47
| Facility | | $5.01 | $7.76 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $10.00
| Professional | | $3.98 | $5.01 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $5.62 / $5.62
| Professional | | $5.62 | $5.62 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $5.62 / $19.50
| Facility | | $5.62 | $5.62 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $5.13 / $15.14
| Professional | | $2.75 | $5.13 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $11.22 / $12.59
| Facility | | $10.47 | $11.22 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $10.47 / $30.90
| Facility | | $7.41 | $10.47 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $5.62 / $7.76
| Professional | | $3.24 | $5.62 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $12.59 / $100.00
| Facility | | $5.01 | $12.59 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.55 / $7.08
| Professional | | $2.34 | $3.55 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.09 / $5.62 / $6.92
| Facility | | $3.09 | $5.62 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.31 / $6.76
| Professional | | $2.34 | $3.31 | $6.76 |