- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.68 / $20.04 / $105.25
| Facility | | $6.68 | $20.04 | $105.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.28 / $5.97 / $8.40
| Professional | | $5.28 | $5.97 | $8.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.68 / $6.68 / $6.68
| Professional | | $6.68 | $6.68 | $6.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.28 / $6.01 / $20.04
| Facility | | $5.28 | $6.01 | $20.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $3.30 / $4.72
| Professional | | $2.73 | $3.30 | $4.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.68 / $7.35 / $9.35
| Facility | | $6.68 | $7.35 | $9.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.34 / $7.01 / $9.02
| Professional | | $4.34 | $7.01 | $9.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.88 / $6.68 / $17.62
| Facility | | $4.88 | $6.68 | $17.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $7.85 / $14.93
| Professional | | $4.40 | $7.85 | $14.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $4.01 / $6.68
| Professional | | $2.81 | $4.01 | $6.68 |