- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $8.13 / $12.02
| Facility | | $3.02 | $8.13 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.02 / $11.48
| Professional | | $2.00 | $3.02 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $8.32 / $10.23
| Professional | | $5.25 | $8.32 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $10.47 / $33.11
| Professional | | $4.27 | $10.47 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.27 / $5.62 / $13.49
| Facility | | $4.27 | $5.62 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $5.13 / $10.96
| Professional | | $2.57 | $5.13 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $5.25 / $5.62
| Professional | | $5.13 | $5.25 | $5.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $5.25 / $5.25
| Facility | | $5.25 | $5.25 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.27 / $4.27 / $9.55
| Facility | | $4.27 | $4.27 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $3.55 / $10.47
| Professional | | $2.57 | $3.55 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $4.27 / $4.27
| Professional | | $3.39 | $4.27 | $4.27 |