- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.41 / $39.52 / $246.56
| Facility | | $8.41 | $39.52 | $246.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.50 / $5.68 / $7.01
| Professional | | $4.50 | $5.68 | $7.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.68 / $6.47 / $10.47
| Professional | | $5.68 | $6.47 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $4.84 / $9.07
| Facility | | $3.72 | $4.84 | $9.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $7.46 / $11.32
| Professional | | $3.72 | $7.46 | $11.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.01 / $8.76 / $10.52
| Professional | | $7.01 | $8.76 | $10.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.94 / $2.94 / $2.94
| Facility | | $2.94 | $2.94 | $2.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.15 / $4.17 / $5.92
| Professional | | $3.15 | $4.17 | $5.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.46 / $6.88 / $6.88
| Professional | | $3.46 | $6.88 | $6.88 |