- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.13 / $16.60 / $43.65
| Facility | | $5.13 | $16.60 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $4.57 / $12.88
| Professional | | $3.02 | $4.57 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $47.86 / $52.48
| Facility | | $6.03 | $47.86 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $3.09 / $6.61
| Professional | | $2.04 | $3.09 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $7.24 / $11.75
| Facility | | $6.03 | $7.24 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $5.75 / $7.41
| Professional | | $3.24 | $5.75 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $5.13 / $6.31
| Professional | | $4.27 | $5.13 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.13 / $16.60 / $43.65
| Facility | | $5.13 | $16.60 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.13 / $12.88
| Professional | | $3.98 | $5.13 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.09 / $5.13 / $10.47
| Professional | | $3.09 | $5.13 | $10.47 |