- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.65 / $6.65 / $10.37
| Facility | | $6.65 | $6.65 | $10.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.83 / $6.65 / $7.99
| Professional | | $2.83 | $6.65 | $7.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.86 / $8.00 / $13.91
| Facility | | $5.86 | $8.00 | $13.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.65 / $7.00 / $9.44
| Professional | | $6.65 | $7.00 | $9.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $8.26 / $10.33
| Professional | | $1.82 | $8.26 | $10.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.15 / $6.65 / $12.22
| Facility | | $3.15 | $6.65 | $12.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.11 / $6.24 / $8.40
| Professional | | $3.11 | $6.24 | $8.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.22 / $5.80 / $7.83
| Professional | | $5.22 | $5.80 | $7.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.01 / $7.00 / $7.00
| Facility | | $4.01 | $7.00 | $7.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $3.35 / $7.00
| Professional | | $2.08 | $3.35 | $7.00 |