- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.48 / $4.80 / $17.23
| Facility | | $3.48 | $4.80 | $17.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $3.64 / $4.26
| Professional | | $2.65 | $3.64 | $4.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.46 / $5.89 / $9.75
| Facility | | $3.46 | $5.89 | $9.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $3.61 / $3.93
| Professional | | $2.46 | $3.61 | $3.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.28 / $3.28 / $40.00
| Facility | | $3.28 | $3.28 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $6.28 / $16.14
| Facility | | $2.13 | $6.28 | $16.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $1.68 / $4.65
| Professional | | $1.51 | $1.68 | $4.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.31 / $1.78 / $5.13
| Professional | | $1.31 | $1.78 | $5.13 |