- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $5.57 / $12.63
| Facility | | $3.01 | $5.57 | $12.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $3.13 / $3.57
| Professional | | $2.81 | $3.13 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $3.23 / $4.01
| Professional | | $1.68 | $3.23 | $4.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.09 / $8.18 / $12.42
| Facility | | $2.09 | $8.18 | $12.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $2.41 / $5.68
| Professional | | $1.53 | $2.41 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.98 / $70.00 / $70.00
| Facility | | $6.98 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.98 / $3.15 / $4.01
| Professional | | $1.98 | $3.15 | $4.01 |