- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.11 / $41.80 / $125.40
| Facility | | $7.11 | $41.80 | $125.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $2.83 / $9.52
| Professional | | $2.15 | $2.83 | $9.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.26 / $15.68 / $25.45
| Facility | | $4.26 | $15.68 | $25.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.46 / $1.94 / $2.23
| Professional | | $1.46 | $1.94 | $2.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.54 / $1.54 / $1.54
| Facility | | $1.54 | $1.54 | $1.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.56 / $2.50 / $4.44
| Professional | | $1.56 | $2.50 | $4.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $2.84 / $2.84
| Professional | | $1.30 | $2.84 | $2.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.11 / $2.84 / $4.63
| Facility | | $2.11 | $2.84 | $4.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $4.44
| Professional | | $2.37 | $2.37 | $4.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $2.00 / $2.37
| Professional | | $1.42 | $2.00 | $2.37 |