- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.86 / $10.74 / $40.79
| Facility | | $5.86 | $10.74 | $40.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.12 / $3.20 / $3.58
| Professional | | $3.12 | $3.20 | $3.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.22 / $4.40 / $7.27
| Facility | | $4.22 | $4.40 | $7.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.88 / $2.69 / $6.81
| Professional | | $1.88 | $2.69 | $6.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.25 / $8.53 / $15.01
| Facility | | $3.25 | $8.53 | $15.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $3.96 / $5.16
| Professional | | $2.50 | $3.96 | $5.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $3.75 / $6.31
| Professional | | $2.06 | $3.75 | $6.31 |