- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.46 / $4.55 / $10.33
| Facility | | $2.46 | $4.55 | $10.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $2.59 / $2.92
| Professional | | $2.46 | $2.59 | $2.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $3.20 / $3.28
| Professional | | $1.67 | $3.20 | $3.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $7.22 / $10.16
| Facility | | $2.13 | $7.22 | $10.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.49 / $1.81 / $4.65
| Professional | | $1.49 | $1.81 | $4.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.03 / $70.00 / $100.00
| Facility | | $8.03 | $70.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.38 / $1.97 / $3.32
| Professional | | $1.38 | $1.97 | $3.32 |