- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $5.62 / $25.12
| Facility | | $5.62 | $5.62 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $25.12
| Professional | | $3.98 | $5.01 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.46 / $44.67 / $48.98
| Facility | | $6.46 | $44.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $3.31 / $6.31
| Professional | | $2.24 | $3.31 | $6.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.61 / $8.13 / $12.59
| Facility | | $6.61 | $8.13 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $6.17 / $8.13
| Professional | | $3.55 | $6.17 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.62 / $6.76
| Professional | | $3.98 | $5.62 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $5.62 / $9.12
| Facility | | $5.62 | $5.62 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.62 / $20.42
| Professional | | $3.98 | $5.62 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $5.62 / $10.47
| Professional | | $3.31 | $5.62 | $10.47 |