- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.81 / $18.69 / $47.37
| Facility | | $5.81 | $18.69 | $47.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $5.81 / $5.81
| Professional | | $5.81 | $5.81 | $5.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $22.88 / $52.33
| Professional | | $5.42 | $22.88 | $52.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.58 / $13.08 / $28.57
| Facility | | $12.58 | $13.08 | $28.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.21 / $9.09 / $11.36
| Professional | | $4.21 | $9.09 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.73 / $15.73 / $15.73
| Professional | | $15.73 | $15.73 | $15.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $3.31 / $7.04
| Professional | | $3.07 | $3.31 | $7.04 |