- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.18 / $7.66 / $31.04
| Facility | | $4.18 | $7.66 | $31.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $3.41 / $7.00
| Professional | | $2.31 | $3.41 | $7.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.48 / $4.09 / $5.18
| Facility | | $3.48 | $4.09 | $5.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.83 / $2.61 / $4.87
| Professional | | $1.83 | $2.61 | $4.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.50 / $6.10 / $10.73
| Facility | | $2.50 | $6.10 | $10.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.79 / $2.83 / $5.16
| Professional | | $1.79 | $2.83 | $5.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.81 / $5.05
| Professional | | $2.00 | $2.81 | $5.05 |