- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.78 / $18.20 / $56.00
| Facility | | $3.78 | $18.20 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $3.10 / $4.92
| Professional | | $2.52 | $3.10 | $4.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $2.34 / $2.34
| Professional | | $2.34 | $2.34 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $4.69 / $11.58
| Facility | | $2.75 | $4.69 | $11.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $1.70 / $7.45
| Professional | | $1.27 | $1.70 | $7.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.47 / $3.80 / $6.08
| Facility | | $2.47 | $3.80 | $6.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $2.47 / $3.80
| Professional | | $2.47 | $2.47 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.87 / $8.36 / $11.48
| Facility | | $3.87 | $8.36 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.38 / $4.54 / $5.68
| Professional | | $2.38 | $4.54 | $5.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $5.73 / $12.01
| Professional | | $3.80 | $5.73 | $12.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.81 / $7.98
| Professional | | $2.02 | $2.81 | $7.98 |