- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.31 / $42.66 / $107.15
| Facility | | $6.31 | $42.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.63 / $12.02
| Professional | | $3.02 | $3.63 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.51 / $2.75
| Professional | | $2.00 | $2.51 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $26.92 / $57.54
| Facility | | $10.72 | $26.92 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.17 / $8.91 / $13.80
| Professional | | $4.17 | $8.91 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $10.00 / $33.11
| Facility | | $2.57 | $10.00 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $2.45 / $5.62
| Professional | | $1.86 | $2.45 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.09 / $4.57 / $11.48
| Facility | | $3.09 | $4.57 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $3.98 / $4.79
| Facility | | $3.63 | $3.98 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.75 / $6.03
| Professional | | $1.70 | $2.75 | $6.03 |