- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $229.40 / $772.52
| Facility | | $4.76 | $229.40 | $772.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $4.65 / $5.55
| Professional | | $3.47 | $4.65 | $5.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.87 / $7.23 / $12.93
| Professional | | $4.87 | $7.23 | $12.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.31 / $10.31 / $20.00
| Facility | | $10.31 | $10.31 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $17.00 / $17.00
| Professional | | $10.65 | $17.00 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.83 / $16.00 / $16.48
| Professional | | $5.83 | $16.00 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $3.89 / $9.77
| Professional | | $2.59 | $3.89 | $9.77 |