- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.03 / $18.42 / $193.76
| Facility | | $5.03 | $18.42 | $193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.15 / $5.03 / $6.75
| Professional | | $3.15 | $5.03 | $6.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.14 / $6.14 / $6.14
| Professional | | $6.14 | $6.14 | $6.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $6.14 / $18.42
| Facility | | $4.84 | $6.14 | $18.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $3.53 / $7.37
| Professional | | $2.68 | $3.53 | $7.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.14 / $6.75 / $8.60
| Facility | | $6.14 | $6.75 | $8.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.99 / $6.45 / $8.28
| Professional | | $3.99 | $6.45 | $8.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.15 / $6.14 / $14.24
| Facility | | $4.15 | $6.14 | $14.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $7.02 / $14.27
| Professional | | $3.73 | $7.02 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $3.68 / $6.14
| Professional | | $2.58 | $3.68 | $6.14 |