- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.95 / $10.51 / $31.82
| Facility | | $3.95 | $10.51 | $31.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.67 / $4.00
| Professional | | $2.61 | $2.67 | $4.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.62 / $3.64 / $4.55
| Facility | | $1.62 | $3.64 | $4.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $2.20 / $2.67
| Professional | | $1.48 | $2.20 | $2.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $4.26 / $13.20
| Facility | | $2.37 | $4.26 | $13.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $4.13 / $5.16
| Professional | | $2.16 | $4.13 | $5.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.17 / $3.64 / $3.82
| Professional | | $0.17 | $3.64 | $3.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.03 / $1.03 / $1.03
| Professional | | $1.03 | $1.03 | $1.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.46 / $5.46 / $5.46
| Facility | | $5.46 | $5.46 | $5.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $1.76 / $3.71
| Professional | | $1.53 | $1.76 | $3.71 |