- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.70 / $8.10 / $26.36
| Facility | | $3.70 | $8.10 | $26.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.64 / $9.27
| Professional | | $2.25 | $2.64 | $9.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $6.53 / $8.16
| Professional | | $4.12 | $6.53 | $8.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.43 / $6.00 / $17.68
| Professional | | $3.43 | $6.00 | $17.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.43 / $5.77 / $16.96
| Facility | | $3.43 | $5.77 | $16.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $3.53 / $8.96
| Professional | | $2.06 | $3.53 | $8.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.21 / $7.01 / $10.75
| Facility | | $4.21 | $7.01 | $10.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $7.01 / $9.83
| Professional | | $4.12 | $7.01 | $9.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.89 / $8.33
| Professional | | $2.06 | $2.89 | $8.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.71 / $3.43 / $3.43
| Professional | | $2.71 | $3.43 | $3.43 |