- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.85 / $10.66 / $23.04
| Facility | | $7.85 | $10.66 | $23.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.58 / $6.58 / $6.96
| Professional | | $6.58 | $6.58 | $6.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.65 / $11.00 / $21.54
| Facility | | $7.65 | $11.00 | $21.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.60 / $4.95 / $11.62
| Professional | | $3.60 | $4.95 | $11.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.05 / $10.13 / $27.68
| Facility | | $5.05 | $10.13 | $27.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.48 / $8.74 / $11.87
| Professional | | $5.48 | $8.74 | $11.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $6.61 / $9.38
| Professional | | $3.80 | $6.61 | $9.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $7.46 / $14.63
| Professional | | $4.13 | $7.46 | $14.63 |