- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.08 / $10.67 / $15.40
| Facility | | $5.08 | $10.67 | $15.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.34 / $10.67 / $10.67
| Professional | | $9.34 | $10.67 | $10.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.07 / $21.59 / $22.61
| Facility | | $20.07 | $21.59 | $22.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $6.89 / $8.67
| Professional | | $6.00 | $6.89 | $8.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.59 / $10.14 / $34.70
| Facility | | $3.59 | $10.14 | $34.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $3.98 / $19.10
| Professional | | $3.34 | $3.98 | $19.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.67 / $9.72 / $12.65
| Facility | | $6.67 | $9.72 | $12.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.11 / $7.41 / $12.60
| Professional | | $7.11 | $7.41 | $12.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.60 / $10.85
| Professional | | $3.53 | $5.60 | $10.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $100.00
| Facility | | $50.00 | $70.00 | $100.00 |