- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.88 / $13.29 / $32.71
| Facility | | $2.88 | $13.29 | $32.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.72 / $4.00
| Professional | | $2.61 | $2.72 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.55 / $4.55 / $4.55
| Professional | | $4.55 | $4.55 | $4.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $3.28 / $3.83
| Facility | | $2.27 | $3.28 | $3.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $1.48 / $2.80
| Professional | | $1.42 | $1.48 | $2.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.64 / $4.37 / $5.09
| Facility | | $3.64 | $4.37 | $5.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.64 / $4.37 / $7.28
| Professional | | $3.64 | $4.37 | $7.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $2.83 / $5.00
| Facility | | $2.37 | $2.83 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.65 / $4.13 / $47.35
| Professional | | $1.65 | $4.13 | $47.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $2.00
| Professional | | $2.00 | $2.00 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $2.37 / $4.19
| Professional | | $1.53 | $2.37 | $4.19 |