- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.98 / $38.44 / $75.59
| Facility | | $5.98 | $38.44 | $75.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.49 / $4.38 / $5.37
| Professional | | $3.49 | $4.38 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.25 / $2.50
| Professional | | $2.25 | $2.25 | $2.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $5.27 / $23.17
| Facility | | $5.01 | $5.27 | $23.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $4.13 / $13.49
| Professional | | $2.48 | $4.13 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.70 / $10.52 / $27.72
| Facility | | $6.70 | $10.52 | $27.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.89 / $5.27 / $7.26
| Professional | | $2.89 | $5.27 | $7.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.38 / $8.63 / $60.00
| Facility | | $4.38 | $8.63 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $3.16 / $6.02
| Professional | | $2.11 | $3.16 | $6.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $3.71 / $6.51
| Professional | | $2.11 | $3.71 | $6.51 |