- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.62 / $6.70 / $15.78
| Facility | | $3.62 | $6.70 | $15.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.21 / $3.81 / $4.26
| Professional | | $3.21 | $3.81 | $4.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $5.01 / $6.15
| Professional | | $2.65 | $5.01 | $6.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.17 / $10.22 / $16.93
| Facility | | $3.17 | $10.22 | $16.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $3.46 / $7.82
| Professional | | $2.24 | $3.46 | $7.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.88 / $60.00 / $100.00
| Facility | | $27.88 | $60.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $3.10 / $6.29
| Professional | | $2.02 | $3.10 | $6.29 |