- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $5.37 / $16.22
| Facility | | $3.47 | $5.37 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.75 / $27.54
| Professional | | $2.00 | $2.75 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $2.19 / $2.19
| Professional | | $2.19 | $2.19 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $4.17 / $7.76
| Facility | | $2.75 | $4.17 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $2.75 / $2.75
| Professional | | $2.57 | $2.75 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.80 / $3.80 / $9.12
| Facility | | $3.80 | $3.80 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.09 / $4.17 / $5.13
| Professional | | $2.09 | $4.17 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $5.37 / $17.38
| Facility | | $3.47 | $5.37 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $3.98 / $5.50
| Professional | | $2.45 | $3.98 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $2.34 / $4.57
| Professional | | $1.86 | $2.34 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.82 / $3.63 / $3.63
| Facility | | $1.82 | $3.63 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $2.45 / $2.57
| Professional | | $1.51 | $2.45 | $2.57 |