- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.11 / $7.65 / $10.27
| Facility | | $6.11 | $7.65 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.84 / $7.88 / $11.88
| Professional | | $5.84 | $7.88 | $11.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $6.86 / $11.53
| Professional | | $6.00 | $6.86 | $11.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.40 / $8.15 / $9.36
| Facility | | $5.40 | $8.15 | $9.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.93 / $6.93 / $8.39
| Professional | | $6.93 | $6.93 | $8.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.76 / $35.61 / $59.76
| Facility | | $8.76 | $35.61 | $59.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $9.50 / $13.57
| Professional | | $6.47 | $9.50 | $13.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.41 / $8.33 / $9.16
| Professional | | $5.41 | $8.33 | $9.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.76 / $6.56 / $8.25
| Professional | | $4.76 | $6.56 | $8.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.33 / $8.33 / $8.33
| Professional | | $8.33 | $8.33 | $8.33 |