- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.73 / $27.80 / $517.65
| Facility | | $2.73 | $27.80 | $517.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $2.75 / $3.48
| Professional | | $1.96 | $2.75 | $3.48 |
- 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
- $6.30 / $6.30 / $44.57
| Facility | | $6.30 | $6.30 | $44.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $2.08 / $3.31
| Professional | | $1.51 | $2.08 | $3.31 |