- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.36 / $3.97 / $19.75
| Facility | | $3.36 | $3.97 | $19.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.78 / $2.84 / $3.36
| Professional | | $1.78 | $2.84 | $3.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.47 / $2.47 / $2.47
| Facility | | $2.47 | $2.47 | $2.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $3.62 / $3.62
| Professional | | $2.46 | $3.62 | $3.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.64 / $2.67 / $5.66
| Facility | | $1.64 | $2.67 | $5.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $2.48 / $3.10
| Professional | | $1.32 | $2.48 | $3.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $2.17 / $3.54
| Professional | | $1.30 | $2.17 | $3.54 |