- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.87 / $36.71 / $62.37
| Facility | | $7.87 | $36.71 | $62.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.26 / $17.82 / $20.39
| Professional | | $4.26 | $17.82 | $20.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.71 / $14.71 / $14.71
| Facility | | $14.71 | $14.71 | $14.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $5.78 / $7.23
| Professional | | $2.36 | $5.78 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.87 / $3.87 / $3.87
| Facility | | $3.87 | $3.87 | $3.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $17.13
| Professional | | $5.32 | $5.32 | $17.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $11.97 / $11.97
| Professional | | $4.79 | $11.97 | $11.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.87 / $3.87 / $3.87
| Facility | | $3.87 | $3.87 | $3.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.21 / $4.79 / $5.32
| Professional | | $4.21 | $4.79 | $5.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $10.64 / $16.05
| Professional | | $2.04 | $10.64 | $16.05 |