- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $11.00 / $21.14
| Facility | | $3.47 | $11.00 | $21.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.77 / $3.43 / $3.43
| Professional | | $2.77 | $3.43 | $3.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.97 / $5.85 / $13.65
| Facility | | $4.97 | $5.85 | $13.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $1.96 / $2.31
| Professional | | $1.21 | $1.96 | $2.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.88 / $14.76 / $21.17
| Facility | | $6.88 | $14.76 | $21.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $2.13 / $4.13
| Professional | | $1.58 | $2.13 | $4.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.09 / $5.37 / $10.98
| Professional | | $4.09 | $5.37 | $10.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $1.81 / $2.43
| Professional | | $1.27 | $1.81 | $2.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.76 / $3.45 / $4.87
| Professional | | $2.76 | $3.45 | $4.87 |