- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.47 / $4.75 / $17.64
| Facility | | $2.47 | $4.75 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $3.35 / $5.83
| Professional | | $2.47 | $3.35 | $5.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $6.80 / $8.61
| Professional | | $5.71 | $6.80 | $8.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.30 / $1.30
| Professional | | $1.30 | $1.30 | $1.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $5.83 / $13.06
| Facility | | $3.07 | $5.83 | $13.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $3.56 / $44.16
| Professional | | $2.46 | $3.56 | $44.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.35 / $3.53 / $6.22
| Professional | | $2.35 | $3.53 | $6.22 |