- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.57 / $76.56 / $123.85
| Facility | | $5.57 | $76.56 | $123.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.48 / $3.94 / $4.84
| Professional | | $3.48 | $3.94 | $4.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.76 / $3.87 / $12.12
| Facility | | $3.76 | $3.87 | $12.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.80 / $5.37 / $6.71
| Professional | | $2.80 | $5.37 | $6.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.40 / $5.05 / $19.80
| Facility | | $4.40 | $5.05 | $19.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.37 / $3.53 / $5.19
| Professional | | $3.37 | $3.53 | $5.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.85 / $2.64
| Professional | | $1.85 | $1.85 | $2.64 |