- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.98 / $19.64 / $61.20
| Facility | | $3.98 | $19.64 | $61.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.77 / $4.20 / $6.05
| Professional | | $3.77 | $4.20 | $6.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.69 / $4.54 / $5.30
| Facility | | $2.69 | $4.54 | $5.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $2.49 / $3.74
| Professional | | $1.50 | $2.49 | $3.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.04 / $6.05 / $7.26
| Facility | | $5.04 | $6.05 | $7.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $6.09 / $10.08
| Professional | | $5.04 | $6.09 | $10.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.28 / $3.92 / $50.00
| Facility | | $3.28 | $3.92 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $5.67 / $24.29
| Professional | | $2.13 | $5.67 | $24.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.77 / $2.77 / $2.77
| Professional | | $2.77 | $2.77 | $2.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $4.43 / $5.04
| Professional | | $2.12 | $4.43 | $5.04 |