- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $16.22 / $81.28
| Facility | | $5.25 | $16.22 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $14.79
| Professional | | $3.98 | $5.01 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.50 / $7.41 / $25.12
| Facility | | $5.50 | $7.41 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $3.39 / $10.96
| Professional | | $2.69 | $3.39 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $10.47 / $25.12
| Facility | | $3.72 | $10.47 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $7.08 / $13.80
| Professional | | $3.55 | $7.08 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $5.50 / $7.59
| Facility | | $2.75 | $5.50 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $3.31 / $7.76
| Professional | | $2.29 | $3.31 | $7.76 |