- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.86 / $21.50 / $27.25
| Facility | | $9.86 | $21.50 | $27.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $9.86 / $16.55
| Professional | | $9.86 | $9.86 | $16.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $0.76 / $0.76
| Facility | | $0.56 | $0.76 | $0.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.72 / $0.75 / $0.76
| Professional | | $0.72 | $0.75 | $0.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.75 / $0.94 / $10.48
| Professional | | $0.75 | $0.94 | $10.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.53 / $18.73 / $100.00
| Facility | | $10.53 | $18.73 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.48 / $10.27 / $10.27
| Professional | | $0.48 | $10.27 | $10.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.71 / $2.92 / $5.86
| Facility | | $2.71 | $2.92 | $5.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $3.82 / $6.37
| Professional | | $2.56 | $3.82 | $6.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.76 / $10.27 / $10.27
| Professional | | $9.76 | $10.27 | $10.27 |