- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.55 / $21.33 / $59.31
| Facility | | $3.55 | $21.33 | $59.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $3.87 / $32.28
| Professional | | $3.31 | $3.87 | $32.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.96 / $24.74 / $48.24
| Facility | | $18.96 | $24.74 | $48.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.81 / $7.62 / $8.23
| Professional | | $3.81 | $7.62 | $8.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $7.23 / $11.42
| Professional | | $5.78 | $7.23 | $11.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $11.26 / $80.00
| Facility | | $3.01 | $11.26 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.01 / $5.01 / $10.03
| Professional | | $3.01 | $5.01 | $10.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.15 / $10.21 / $15.74
| Facility | | $6.15 | $10.21 | $15.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $10.75 / $14.45
| Professional | | $6.47 | $10.75 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.01 / $5.01 / $10.03
| Professional | | $3.01 | $5.01 | $10.03 |