- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.61 / $98.37 / $166.45
| Facility | | $5.61 | $98.37 | $166.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $4.78 / $5.61
| Professional | | $2.59 | $4.78 | $5.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $3.39 / $3.39
| Professional | | $2.93 | $3.39 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.50 / $7.88 / $10.61
| Facility | | $6.50 | $7.88 | $10.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.41 / $2.54 / $3.54
| Professional | | $2.41 | $2.54 | $3.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.82 / $5.16 / $15.40
| Facility | | $3.82 | $5.16 | $15.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $3.76 / $7.23
| Professional | | $2.56 | $3.76 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.67 / $6.06
| Professional | | $2.04 | $2.67 | $6.06 |