- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.44 / $17.28 / $19.16
| Facility | | $9.44 | $17.28 | $19.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $10.38 / $18.12
| Professional | | $7.46 | $10.38 | $18.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.65 / $12.65 / $12.65
| Facility | | $12.65 | $12.65 | $12.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.65 / $12.65 / $12.65
| Professional | | $12.65 | $12.65 | $12.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.14 / $7.64 / $13.68
| Facility | | $6.14 | $7.64 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $4.50 / $13.42
| Professional | | $4.12 | $4.50 | $13.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.96 / $5.03 / $14.16
| Professional | | $3.96 | $5.03 | $14.16 |