- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $43.65 / $95.50
| Facility | | $3.47 | $43.65 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.24 / $8.32
| Professional | | $2.00 | $3.24 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.55 / $1.95 / $6.31
| Professional | | $1.55 | $1.95 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.63 / $5.01 / $5.01
| Professional | | $2.63 | $5.01 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $8.71 / $14.79
| Facility | | $2.40 | $8.71 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.62 / $2.82 / $5.62
| Professional | | $1.62 | $2.82 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $8.32 / $8.32
| Professional | | $3.31 | $8.32 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.32 / $2.51 / $3.63
| Facility | | $1.32 | $2.51 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.55 / $2.40 / $4.07
| Professional | | $1.55 | $2.40 | $4.07 |