- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.32 / $20.30 / $116.87
| Facility | | $4.32 | $20.30 | $116.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $15.09 / $15.71
| Professional | | $2.52 | $15.09 | $15.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.59 / $10.59 / $12.03
| Professional | | $10.59 | $10.59 | $12.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.60 / $18.60 / $45.36
| Facility | | $11.60 | $18.60 | $45.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $19.07 / $26.85
| Professional | | $11.53 | $19.07 | $26.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.06 / $17.03 / $27.46
| Facility | | $3.06 | $17.03 | $27.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.26 / $10.59 / $17.39
| Professional | | $4.26 | $10.59 | $17.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $3.23 / $4.03
| Professional | | $2.94 | $3.23 | $4.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $7.41 / $12.95
| Professional | | $1.77 | $7.41 | $12.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.67 / $3.67 / $9.14
| Professional | | $3.67 | $3.67 | $9.14 |