- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.00 / $12.30 / $16.48
| Facility | | $7.00 | $12.30 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $5.83 / $48.03
| Professional | | $5.60 | $5.83 | $48.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.33 / $7.47 / $9.34
| Facility | | $3.33 | $7.47 | $9.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.30 / $4.51 / $5.48
| Professional | | $3.30 | $4.51 | $5.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.86 / $8.75 / $27.07
| Facility | | $4.86 | $8.75 | $27.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $8.67 / $10.84
| Professional | | $5.04 | $8.67 | $10.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.09 / $7.47 / $7.84
| Professional | | $0.09 | $7.47 | $7.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.29
| Professional | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.21 / $11.21 / $11.21
| Facility | | $11.21 | $11.21 | $11.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $3.82 / $7.47
| Professional | | $3.14 | $3.82 | $7.47 |