- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.08 / $7.60 / $41.50
| Facility | | $3.08 | $7.60 | $41.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.08 / $4.01 / $4.51
| Professional | | $3.08 | $4.01 | $4.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.68 / $5.07 / $30.26
| Facility | | $3.68 | $5.07 | $30.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.52 / $1.52 / $3.45
| Professional | | $1.52 | $1.52 | $3.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.97 / $4.84 / $6.66
| Facility | | $3.97 | $4.84 | $6.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $4.54 / $5.68
| Professional | | $3.93 | $4.54 | $5.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $3.80 / $4.59
| Professional | | $3.80 | $3.80 | $4.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.08 / $4.93 / $41.50
| Facility | | $3.08 | $4.93 | $41.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.08 / $3.97 / $4.51
| Professional | | $3.08 | $3.97 | $4.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.37 / $5.73
| Professional | | $2.27 | $2.37 | $5.73 |