- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.23 / $7.16 / $12.46
| Facility | | $6.23 | $7.16 | $12.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.34 / $7.00 / $7.16
| Professional | | $5.34 | $7.00 | $7.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.65 / $4.44 / $5.97
| Facility | | $3.65 | $4.44 | $5.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.64 / $1.73 / $2.41
| Professional | | $1.64 | $1.73 | $2.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.05 / $5.08 / $19.51
| Facility | | $4.05 | $5.08 | $19.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $4.30 / $8.77
| Professional | | $2.72 | $4.30 | $8.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $3.74 / $6.23
| Professional | | $2.10 | $3.74 | $6.23 |