- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.41 / $6.47 / $34.79
| Facility | | $2.41 | $6.47 | $34.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.27 / $4.32
| Professional | | $2.11 | $2.27 | $4.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $3.25 / $8.34
| Facility | | $2.54 | $3.25 | $8.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $2.94
| Professional | | $1.25 | $1.25 | $2.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.86 / $4.25 / $8.68
| Facility | | $1.86 | $4.25 | $8.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.65 / $2.89 / $3.68
| Professional | | $1.65 | $2.89 | $3.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.52 / $3.55
| Professional | | $1.07 | $1.52 | $3.55 |