- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $10.72 / $19.50
| Facility | | $5.25 | $10.72 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $5.01 / $7.08
| Professional | | $3.02 | $5.01 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.80 / $7.41 / $10.23
| Facility | | $3.80 | $7.41 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.88 / $4.47 / $12.02
| Professional | | $2.88 | $4.47 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.98 / $3.98 / $3.98
| Facility | | $3.98 | $3.98 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.75 / $11.48 / $17.78
| Facility | | $5.75 | $11.48 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $7.08 / $8.71
| Professional | | $3.63 | $7.08 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $8.32 / $20.89
| Professional | | $6.46 | $8.32 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $5.25 / $7.24
| Facility | | $3.47 | $5.25 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $3.89 / $10.72
| Professional | | $2.45 | $3.89 | $10.72 |