- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.80 / $68.37 / $120.82
| Facility | | $9.80 | $68.37 | $120.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Professional | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.81 / $20.09 / $45.90
| Professional | | $3.81 | $20.09 | $45.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.73 / $8.02 / $17.86
| Facility | | $7.73 | $8.02 | $17.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $5.78 / $7.23
| Professional | | $2.68 | $5.78 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.68 / $9.68 / $9.68
| Professional | | $9.68 | $9.68 | $9.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.70 / $2.70 / $2.70
| Facility | | $2.70 | $2.70 | $2.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $2.91 / $4.33
| Professional | | $2.70 | $2.91 | $4.33 |