- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.43 / $15.28 / $128.61
| Facility | | $5.43 | $15.28 | $128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $3.48 / $24.63
| Professional | | $2.57 | $3.48 | $24.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $2.66 / $2.66
| Professional | | $2.66 | $2.66 | $2.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.42 / $9.21 / $15.86
| Facility | | $2.42 | $9.21 | $15.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $3.66 / $5.21
| Professional | | $2.50 | $3.66 | $5.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.67 / $6.23 / $11.21
| Facility | | $2.67 | $6.23 | $11.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $4.54 / $5.68
| Professional | | $2.50 | $4.54 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.06 / $3.48 / $85.54
| Facility | | $3.06 | $3.48 | $85.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $2.24 / $3.52
| Professional | | $1.61 | $2.24 | $3.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $2.24 / $3.52
| Professional | | $1.61 | $2.24 | $3.52 |