- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.05 / $35.50 / $54.46
| Facility | | $29.05 | $35.50 | $54.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.14 / $3.14
| Professional | | $2.06 | $2.14 | $3.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $4.78 / $5.33
| Professional | | $3.57 | $4.78 | $5.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $2.50 / $3.15
| Professional | | $2.48 | $2.50 | $3.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.68 / $4.98 / $43.45
| Facility | | $1.68 | $4.98 | $43.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $2.60 / $4.05
| Professional | | $1.42 | $2.60 | $4.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $2.60 / $4.05
| Professional | | $1.42 | $2.60 | $4.05 |