- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $15.48 / $56.95
| Facility | | $2.40 | $15.48 | $56.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $2.98 / $3.12
| Professional | | $2.68 | $2.98 | $3.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.76 / $23.46 / $39.54
| Facility | | $8.76 | $23.46 | $39.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.43 / $4.00 / $9.00
| Professional | | $3.43 | $4.00 | $9.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.24 / $9.94 / $19.75
| Facility | | $6.24 | $9.94 | $19.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $2.21 / $5.16
| Professional | | $1.81 | $2.21 | $5.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.68 / $3.97 / $6.73
| Facility | | $2.68 | $3.97 | $6.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $4.93 / $7.00
| Professional | | $4.00 | $4.93 | $7.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $1.89 / $2.72
| Professional | | $1.89 | $1.89 | $2.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.44 / $2.06 / $4.80
| Professional | | $1.44 | $2.06 | $4.80 |