- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.91 / $41.50 / $60.30
| Facility | | $15.91 | $41.50 | $60.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.14 / $4.55
| Professional | | $2.06 | $2.14 | $4.55 |
- 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
- $2.35 / $15.05 / $30.92
| Facility | | $2.35 | $15.05 | $30.92 |
- 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 |