- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.74 / $10.36 / $14.68
| Facility | | $5.74 | $10.36 | $14.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.51 / $4.09 / $5.00
| Professional | | $3.51 | $4.09 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $9.14 / $11.42
| Professional | | $5.78 | $9.14 | $11.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $7.98 / $12.63
| Professional | | $5.32 | $7.98 | $12.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.05 / $6.39 / $16.87
| Facility | | $5.05 | $6.39 | $16.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.54 / $5.32 / $11.66
| Professional | | $4.54 | $5.32 | $11.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.99 / $7.76 / $11.66
| Facility | | $3.99 | $7.76 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $7.58 / $11.66
| Professional | | $5.03 | $7.58 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.54 / $5.32 / $9.31
| Professional | | $4.54 | $5.32 | $9.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $5.32 / $5.32
| Professional | | $4.20 | $5.32 | $5.32 |