- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.16 / $108.30 / $181.60
| Facility | | $6.16 | $108.30 | $181.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $4.99 / $10.00
| Professional | | $4.37 | $4.99 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.36 / $3.36 / $3.36
| Professional | | $3.36 | $3.36 | $3.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.49 / $5.60 / $7.00
| Facility | | $2.49 | $5.60 | $7.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.38 / $5.42
| Professional | | $2.72 | $3.38 | $5.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.64 / $6.55 / $20.27
| Facility | | $3.64 | $6.55 | $20.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $6.20 / $7.74
| Professional | | $4.13 | $6.20 | $7.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.07 / $5.60 / $5.88
| Professional | | $0.07 | $5.60 | $5.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $1.89 / $1.89
| Professional | | $1.89 | $1.89 | $1.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.35 / $3.23 / $5.60
| Professional | | $2.35 | $3.23 | $5.60 |