- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $34.20 / $90.45
| Facility | | $2.57 | $34.20 | $90.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.39 / $3.31 / $4.82
| Professional | | $2.39 | $3.31 | $4.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.55 / $7.40 / $8.30
| Professional | | $5.55 | $7.40 | $8.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $4.17 / $5.25
| Professional | | $4.13 | $4.17 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.61 / $7.71 / $57.27
| Facility | | $2.61 | $7.71 | $57.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.84 / $4.40 / $6.29
| Professional | | $1.84 | $4.40 | $6.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.54 / $2.57 / $6.29
| Professional | | $1.54 | $2.57 | $6.29 |