- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.01 / $7.78 / $56.13
| Facility | | $4.01 | $7.78 | $56.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $3.89 / $7.40
| Professional | | $2.81 | $3.89 | $7.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.06 / $4.88 / $12.89
| Facility | | $3.06 | $4.88 | $12.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $2.54 / $6.77
| Professional | | $1.26 | $2.54 | $6.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $4.23 / $6.77
| Facility | | $2.75 | $4.23 | $6.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $4.23
| Professional | | $2.75 | $2.75 | $4.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.09 / $9.31 / $12.53
| Facility | | $4.09 | $9.31 | $12.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.94 / $4.96 / $6.20
| Professional | | $1.94 | $4.96 | $6.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.23 / $6.37 / $27.80
| Professional | | $4.23 | $6.37 | $27.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $4.41 / $5.39
| Professional | | $2.54 | $4.41 | $5.39 |