- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.57 / $9.38 / $187.68
| Facility | | $4.57 | $9.38 | $187.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.48 / $3.65 / $3.65
| Professional | | $3.48 | $3.65 | $3.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.86 / $2.86 / $2.86
| Facility | | $2.86 | $2.86 | $2.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $5.37 / $8.34
| Professional | | $3.20 | $5.37 | $8.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.40 / $11.70 / $20.58
| Facility | | $4.40 | $11.70 | $20.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $2.64 / $6.16
| Professional | | $1.85 | $2.64 | $6.16 |