- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.38 / $35.72 / $74.84
| Facility | | $16.38 | $35.72 | $74.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.37 / $2.70
| Professional | | $2.00 | $2.37 | $2.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.31 / $2.38 / $7.46
| Facility | | $2.31 | $2.38 | $7.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $2.89 / $3.61
| Professional | | $1.71 | $2.89 | $3.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.70 / $3.11 / $12.15
| Facility | | $2.70 | $3.11 | $12.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.17 / $3.19
| Professional | | $2.06 | $2.17 | $3.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.60 / $1.62
| Professional | | $1.12 | $1.60 | $1.62 |