- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $3.76 / $22.86
| Facility | | $3.37 | $3.76 | $22.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.76 / $3.76 / $4.19
| Professional | | $3.76 | $3.76 | $4.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.55 / $40.93 / $104.45
| Facility | | $12.55 | $40.93 | $104.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.82 / $7.00 / $11.00
| Professional | | $4.82 | $7.00 | $11.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.75 / $13.96 / $29.63
| Facility | | $8.75 | $13.96 | $29.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.89 / $7.23
| Professional | | $2.29 | $2.89 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.76 / $5.20 / $8.81
| Facility | | $3.76 | $5.20 | $8.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $6.45 / $9.00
| Professional | | $5.00 | $6.45 | $9.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $3.82
| Professional | | $2.65 | $2.65 | $3.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $3.07 / $6.29
| Professional | | $2.02 | $3.07 | $6.29 |