- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $23.21 / $44.56
| Facility | | $12.68 | $23.21 | $44.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.36 / $6.36 / $8.07
| Professional | | $6.36 | $6.36 | $8.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.55 / $43.32 / $55.52
| Facility | | $10.55 | $43.32 | $55.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $5.81 / $11.06
| Professional | | $4.07 | $5.81 | $11.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.26 / $18.50 / $32.52
| Facility | | $7.26 | $18.50 | $32.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.55 / $8.57 / $11.36
| Professional | | $5.55 | $8.57 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.71 / $5.66 / $12.40
| Professional | | $2.71 | $5.66 | $12.40 |