- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.30 / $13.36 / $14.82
| Facility | | $7.30 | $13.36 | $14.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $8.02 / $14.02
| Professional | | $5.77 | $8.02 | $14.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.67 / $10.67 / $10.67
| Facility | | $10.67 | $10.67 | $10.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.67 / $10.67 / $10.67
| Professional | | $10.67 | $10.67 | $10.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.75 / $7.56 / $14.65
| Facility | | $4.75 | $7.56 | $14.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.28 / $4.76 / $10.84
| Professional | | $3.28 | $4.76 | $10.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $4.38 / $18.70
| Professional | | $3.07 | $4.38 | $18.70 |