- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.01 / $60.51 / $76.36
| Facility | | $12.01 | $60.51 | $76.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $10.10 / $10.10
| Professional | | $3.63 | $10.10 | $10.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.05 / $5.49 / $20.22
| Facility | | $5.05 | $5.49 | $20.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.19 / $5.78 / $7.23
| Professional | | $3.19 | $5.78 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.87 / $9.03 / $10.61
| Facility | | $4.87 | $9.03 | $10.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $5.18 / $6.22
| Professional | | $5.18 | $5.18 | $6.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.77 / $11.66 / $19.05
| Facility | | $7.77 | $11.66 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $8.73 / $9.36
| Professional | | $4.40 | $8.73 | $9.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.18 / $3.08 / $10.59
| Professional | | $2.18 | $3.08 | $10.59 |