- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $11.04 / $27.03
| Facility | | $6.03 | $11.04 | $27.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.84 / $3.85 / $3.85
| Professional | | $3.84 | $3.85 | $3.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $5.54 / $7.47
| Facility | | $5.01 | $5.54 | $7.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $3.53 / $7.02
| Professional | | $2.47 | $3.53 | $7.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.50 / $8.81 / $15.48
| Facility | | $3.50 | $8.81 | $15.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $4.07 / $7.23
| Professional | | $2.68 | $4.07 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $4.04 / $7.52
| Professional | | $2.10 | $4.04 | $7.52 |