- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $60.26 / $89.13
| Facility | | $18.62 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.09 / $8.13
| Professional | | $2.00 | $2.09 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $7.41
| Facility | | $7.41 | $7.41 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.88 / $3.63
| Professional | | $2.00 | $2.88 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $2.69 / $75.86
| Facility | | $2.34 | $2.69 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $3.16 / $10.72
| Professional | | $2.69 | $3.16 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.33 / $10.47 / $17.38
| Facility | | $9.33 | $10.47 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.03 / $6.03
| Professional | | $5.01 | $6.03 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.34 / $2.34 / $2.34
| Facility | | $2.34 | $2.34 | $2.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.69 / $3.47
| Professional | | $2.00 | $2.69 | $3.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $5.37 / $8.13
| Professional | | $1.70 | $5.37 | $8.13 |