- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.30 / $8.40 / $14.60
| Facility | | $7.30 | $8.40 | $14.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.02 / $8.40 / $8.40
| Professional | | $8.02 | $8.40 | $8.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.50 / $7.88 / $10.61
| Facility | | $6.50 | $7.88 | $10.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $5.33 / $7.46
| Professional | | $5.05 | $5.33 | $7.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.71 / $7.68 / $22.59
| Facility | | $5.71 | $7.68 | $22.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.77 / $5.62 / $10.84
| Professional | | $3.77 | $5.62 | $10.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $4.28 / $12.75
| Professional | | $3.07 | $4.28 | $12.75 |