- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.38 / $70.73 / $176.65
| Facility | | $8.38 | $70.73 | $176.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.34 / $5.01 / $6.75
| Professional | | $4.34 | $5.01 | $6.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.11 / $16.70 / $26.47
| Facility | | $6.11 | $16.70 | $26.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $2.42 / $4.68
| Professional | | $2.42 | $2.42 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.38 / $5.53 / $14.89
| Facility | | $3.38 | $5.53 | $14.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.98 / $8.26
| Professional | | $3.53 | $5.98 | $8.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.38 / $6.94 / $11.40
| Facility | | $4.38 | $6.94 | $11.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.87 / $7.51 / $16.00
| Professional | | $3.87 | $7.51 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.28 / $7.28 / $7.28
| Facility | | $7.28 | $7.28 | $7.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $3.33 / $5.78
| Professional | | $2.43 | $3.33 | $5.78 |