- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.44 / $40.04 / $157.63
| Facility | | $5.44 | $40.04 | $157.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $5.78 / $6.63
| Professional | | $5.56 | $5.78 | $6.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.28 / $8.28 / $8.28
| Professional | | $8.28 | $8.28 | $8.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.13 / $5.97 / $6.97
| Facility | | $4.13 | $5.97 | $6.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.27 / $5.63 / $6.81
| Professional | | $3.27 | $5.63 | $6.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.63 / $7.96 / $9.27
| Facility | | $6.63 | $7.96 | $9.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $7.96 / $13.26
| Professional | | $6.63 | $7.96 | $13.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.30 / $5.16 / $12.66
| Facility | | $4.30 | $5.16 | $12.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.30 / $7.46 / $42.25
| Professional | | $3.30 | $7.46 | $42.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.65 / $3.65 / $3.65
| Professional | | $3.65 | $3.65 | $3.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.78 / $5.56 / $9.26
| Professional | | $2.78 | $5.56 | $9.26 |