- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.67 / $11.67 / $16.82
| Facility | | $11.67 | $11.67 | $16.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.53 / $12.62 / $12.62
| Professional | | $4.53 | $12.62 | $12.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.32 / $6.86 / $25.26
| Facility | | $6.32 | $6.86 | $25.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.95 / $7.43 / $9.28
| Professional | | $3.95 | $7.43 | $9.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.08 / $11.30 / $13.25
| Facility | | $6.08 | $11.30 | $13.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $6.47 / $7.76
| Professional | | $6.47 | $6.47 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $6.47 / $6.47
| Professional | | $6.47 | $6.47 | $6.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.71 / $14.56 / $23.81
| Facility | | $9.71 | $14.56 | $23.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $11.06 / $11.12
| Professional | | $5.50 | $11.06 | $11.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.85 / $10.64
| Professional | | $2.72 | $3.85 | $10.64 |