- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.17 / $52.75 / $72.54
| Facility | | $4.17 | $52.75 | $72.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.27 / $4.61 / $4.61
| Professional | | $3.27 | $4.61 | $4.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $2.57
| Facility | | $2.57 | $2.57 | $2.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.84 / $4.54 / $7.36
| Professional | | $2.84 | $4.54 | $7.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.01 / $10.51 / $10.51
| Facility | | $10.01 | $10.51 | $10.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $2.37 / $5.51
| Professional | | $1.66 | $2.37 | $5.51 |