- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.67 / $10.65 / $80.52
| Facility | | $3.67 | $10.65 | $80.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $1.98 / $13.36
| Professional | | $1.81 | $1.98 | $13.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $3.07 / $3.07
| Professional | | $3.07 | $3.07 | $3.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.02 / $6.55 / $14.86
| Facility | | $2.02 | $6.55 | $14.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $2.02 / $2.65
| Professional | | $1.74 | $2.02 | $2.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.81 / $1.81 / $1.81
| Facility | | $1.81 | $1.81 | $1.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $1.81 / $1.81
| Professional | | $1.81 | $1.81 | $1.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.52 / $3.10 / $14.95
| Facility | | $2.52 | $3.10 | $14.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.52 / $125.33
| Professional | | $2.52 | $2.52 | $125.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $1.81 / $2.00
| Professional | | $1.81 | $1.81 | $2.00 |