- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.89 / $13.18 / $20.89
| Facility | | $5.89 | $13.18 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $4.27 / $5.62
| Professional | | $3.98 | $4.27 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $3.31 / $3.47
| Professional | | $3.31 | $3.31 | $3.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $16.98 / $18.20
| Facility | | $11.48 | $16.98 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $8.32 / $8.32
| Professional | | $8.32 | $8.32 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $7.76 / $12.59
| Facility | | $3.31 | $7.76 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.51 / $6.31 / $14.13
| Professional | | $2.51 | $6.31 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.27 / $4.27 / $10.23
| Facility | | $4.27 | $4.27 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.55 / $8.91
| Professional | | $2.34 | $3.55 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $5.62 / $6.61
| Facility | | $2.75 | $5.62 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.55 / $7.24
| Professional | | $2.34 | $3.55 | $7.24 |