- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $10.46 / $157.50
| Facility | | $3.01 | $10.46 | $157.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.87 / $3.47 / $13.68
| Professional | | $2.87 | $3.47 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.92 / $1.92 / $1.92
| Professional | | $1.92 | $1.92 | $1.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $4.07 / $4.25
| Professional | | $2.11 | $4.07 | $4.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $8.02 / $14.67
| Facility | | $2.65 | $8.02 | $14.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.79 / $2.94 / $5.68
| Professional | | $1.79 | $2.94 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.85 / $85.54 / $85.54
| Facility | | $8.85 | $85.54 | $85.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $2.29 / $4.22
| Professional | | $1.61 | $2.29 | $4.22 |