- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.51 / $46.75 / $97.20
| Facility | | $10.51 | $46.75 | $97.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.64 / $8.18 / $9.61
| Professional | | $5.64 | $8.18 | $9.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.62 / $46.42 / $75.37
| Facility | | $12.62 | $46.42 | $75.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $5.73 / $6.59
| Professional | | $4.30 | $5.73 | $6.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.55 / $4.55 / $4.55
| Facility | | $4.55 | $4.55 | $4.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.36 / $8.26 / $13.32
| Professional | | $4.36 | $8.26 | $13.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.86 / $3.86 / $3.86
| Professional | | $3.86 | $3.86 | $3.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.58 / $8.41 / $13.69
| Facility | | $5.58 | $8.41 | $13.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.01 / $7.01 / $13.32
| Professional | | $7.01 | $7.01 | $13.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $4.17 / $4.30
| Professional | | $2.94 | $4.17 | $4.30 |