- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.31 / $10.09 / $57.60
| Facility | | $5.31 | $10.09 | $57.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $5.60 / $6.10
| Professional | | $5.31 | $5.60 | $6.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.11 / $6.14 / $19.41
| Facility | | $5.11 | $6.14 | $19.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.18 / $3.19 / $4.76
| Professional | | $3.18 | $3.19 | $4.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.47 / $7.76 / $8.73
| Facility | | $6.47 | $7.76 | $8.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $7.44 / $9.17
| Professional | | $6.47 | $7.44 | $9.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.74 / $6.47 / $16.76
| Facility | | $4.74 | $6.47 | $16.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.26 / $7.43 / $17.18
| Professional | | $4.26 | $7.43 | $17.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.58 / $5.58 / $5.58
| Facility | | $5.58 | $5.58 | $5.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.89 / $6.47
| Professional | | $2.72 | $3.89 | $6.47 |