- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.70 / $10.25 / $85.40
| Facility | | $3.70 | $10.25 | $85.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.70 / $4.30 / $5.56
| Professional | | $3.70 | $4.30 | $5.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.88 / $6.51 / $19.23
| Facility | | $3.88 | $6.51 | $19.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $2.34 / $9.84
| Professional | | $1.75 | $2.34 | $9.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.45 / $5.56 / $8.90
| Facility | | $3.45 | $5.56 | $8.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.61 / $3.61 / $5.56
| Professional | | $3.61 | $3.61 | $5.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.48 / $12.23 / $16.73
| Facility | | $5.48 | $12.23 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.90 / $6.61 / $8.26
| Professional | | $2.90 | $6.61 | $8.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.08 / $7.23 / $17.07
| Professional | | $6.08 | $7.23 | $17.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.79 / $3.47 / $10.05
| Professional | | $2.79 | $3.47 | $10.05 |