- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.34 / $40.47 / $112.56
| Facility | | $23.34 | $40.47 | $112.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $4.48 / $7.42
| Professional | | $3.47 | $4.48 | $7.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $9.97 / $11.14
| Professional | | $7.46 | $9.97 | $11.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $5.84 / $7.34
| Professional | | $5.78 | $5.84 | $7.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.51 / $19.48 / $53.36
| Facility | | $3.51 | $19.48 | $53.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $3.46 / $8.49
| Professional | | $2.48 | $3.46 | $8.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $3.46 / $8.49
| Professional | | $2.08 | $3.46 | $8.49 |