- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.54 / $19.78 / $40.65
| Facility | | $4.54 | $19.78 | $40.65 |
- 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
- $3.64 / $3.64 / $3.64
| Professional | | $3.64 | $3.64 | $3.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.32 / $21.27 / $56.05
| Facility | | $6.32 | $21.27 | $56.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.64 / $3.64 / $7.60
| Professional | | $3.64 | $3.64 | $7.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.63 / $10.57 / $21.73
| Facility | | $6.63 | $10.57 | $21.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.64 / $1.87 / $5.16
| Professional | | $1.64 | $1.87 | $5.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.73 / $3.82 / $5.87
| Facility | | $2.73 | $3.82 | $5.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $4.29 / $6.00
| Professional | | $3.00 | $4.29 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $2.88
| Professional | | $2.00 | $2.00 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.28 / $3.28 / $4.37
| Facility | | $3.28 | $3.28 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $2.18 / $4.37
| Professional | | $1.53 | $2.18 | $4.37 |