- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.50 / $11.60 / $18.66
| Facility | | $5.50 | $11.60 | $18.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.64 / $4.36 / $5.00
| Professional | | $2.64 | $4.36 | $5.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.92 / $6.07 / $9.09
| Facility | | $4.92 | $6.07 | $9.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.09 / $6.09 / $19.78
| Professional | | $6.09 | $6.09 | $19.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.29 / $6.28 / $27.72
| Facility | | $3.29 | $6.28 | $27.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.04 / $7.23 / $13.00
| Professional | | $3.04 | $7.23 | $13.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.44 / $4.44 / $9.28
| Facility | | $4.44 | $4.44 | $9.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $3.62 / $10.07
| Professional | | $2.10 | $3.62 | $10.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.50 / $5.00 / $6.25
| Facility | | $2.50 | $5.00 | $6.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $3.00 / $10.40
| Professional | | $2.10 | $3.00 | $10.40 |