- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.40 / $55.76 / $62.88
| Facility | | $7.40 | $55.76 | $62.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $3.94 / $4.51
| Professional | | $3.34 | $3.94 | $4.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.32 / $5.56 / $9.17
| Facility | | $5.32 | $5.56 | $9.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $3.39 / $8.60
| Professional | | $2.37 | $3.39 | $8.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.25 / $10.79 / $18.97
| Facility | | $4.25 | $10.79 | $18.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.22 / $5.00 / $6.71
| Professional | | $3.22 | $5.00 | $6.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $3.30 / $7.23
| Professional | | $1.58 | $3.30 | $7.23 |