- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.85 / $10.85 / $15.63
| Facility | | $10.85 | $10.85 | $15.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.21 / $11.72 / $11.72
| Professional | | $4.21 | $11.72 | $11.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.87 / $6.37 / $23.46
| Facility | | $5.87 | $6.37 | $23.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.65 / $7.02 / $8.77
| Professional | | $3.65 | $7.02 | $8.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.65 / $10.48 / $12.31
| Facility | | $5.65 | $10.48 | $12.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $6.01 / $7.21
| Professional | | $6.01 | $6.01 | $7.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $6.01 / $6.01
| Professional | | $6.01 | $6.01 | $6.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.02 / $13.52 / $22.12
| Facility | | $9.02 | $13.52 | $22.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.11 / $10.48 / $10.54
| Professional | | $5.11 | $10.48 | $10.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $3.57 / $9.89
| Professional | | $2.52 | $3.57 | $9.89 |