- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.50 / $27.36 / $28.88
| Facility | | $25.50 | $27.36 | $28.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $5.98 / $11.07
| Professional | | $4.51 | $5.98 | $11.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.33 / $34.33 / $55.75
| Facility | | $9.33 | $34.33 | $55.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.18 / $4.24 / $4.87
| Professional | | $3.18 | $4.24 | $4.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $3.37 / $3.37
| Facility | | $3.37 | $3.37 | $3.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.27 / $5.78 / $9.86
| Professional | | $3.27 | $5.78 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.85 / $2.85 / $2.85
| Professional | | $2.85 | $2.85 | $2.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.61 / $6.22 / $8.94
| Facility | | $4.61 | $6.22 | $8.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.74 / $5.18 / $9.86
| Professional | | $4.74 | $5.18 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.18 / $3.08 / $3.18
| Professional | | $2.18 | $3.08 | $3.18 |