- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.16 / $25.93 / $107.74
| Facility | | $8.16 | $25.93 | $107.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.23 / $8.68 / $10.33
| Professional | | $7.23 | $8.68 | $10.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.43 / $9.30 / $10.86
| Facility | | $6.43 | $9.30 | $10.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $12.79 / $12.79
| Professional | | $5.09 | $12.79 | $12.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.33 / $14.46 / $17.04
| Facility | | $10.33 | $14.46 | $17.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.05 / $13.43 / $20.66
| Professional | | $11.05 | $13.43 | $20.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.71 / $8.03 / $22.16
| Facility | | $6.71 | $8.03 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.28 / $11.62 / $58.75
| Professional | | $5.28 | $11.62 | $58.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.68 / $5.68 / $5.68
| Professional | | $5.68 | $5.68 | $5.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.34 / $8.66 / $14.43
| Professional | | $4.34 | $8.66 | $14.43 |