- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.41 / $12.77 / $81.31
| Facility | | $4.41 | $12.77 | $81.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $3.29 / $4.00
| Professional | | $2.04 | $3.29 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.31 / $12.67 / $18.77
| Facility | | $11.31 | $12.67 | $18.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.87 / $6.75 / $6.75
| Professional | | $4.87 | $6.75 | $6.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $4.70 / $20.42
| Facility | | $2.54 | $4.70 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $5.68 / $14.00
| Professional | | $2.27 | $5.68 | $14.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.32 / $3.32 / $9.94
| Facility | | $3.32 | $3.32 | $9.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $2.70 / $7.55
| Professional | | $1.68 | $2.70 | $7.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $2.40 / $6.40
| Professional | | $1.68 | $2.40 | $6.40 |