- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $31.25 / $57.73
| Facility | | $2.37 | $31.25 | $57.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $2.75 / $2.84
| Professional | | $1.96 | $2.75 | $2.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.54 / $1.54 / $1.54
| Facility | | $1.54 | $1.54 | $1.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.78 / $2.48 / $4.42
| Professional | | $1.78 | $2.48 | $4.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $6.30 / $44.57
| Facility | | $2.37 | $6.30 | $44.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $1.90 / $3.31
| Professional | | $1.51 | $1.90 | $3.31 |