- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.76 / $3.07 / $18.67
| Facility | | $2.76 | $3.07 | $18.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $3.15 / $4.70
| Professional | | $3.07 | $3.15 | $4.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.55 / $30.18 / $53.55
| Facility | | $7.55 | $30.18 | $53.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.94 / $5.00 / $10.00
| Professional | | $3.94 | $5.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.16 / $11.42 / $23.71
| Facility | | $7.16 | $11.42 | $23.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $3.03 / $11.50
| Professional | | $1.97 | $3.03 | $11.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $4.55 / $7.71
| Facility | | $3.07 | $4.55 | $7.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $5.64 / $8.00
| Professional | | $4.00 | $5.64 | $8.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.17 / $2.17 / $3.12
| Professional | | $2.17 | $2.17 | $3.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.65 / $2.36 / $5.51
| Professional | | $1.65 | $2.36 | $5.51 |