- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $5.87 / $10.25
| Facility | | $3.20 | $5.87 | $10.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $3.81 / $3.93
| Professional | | $2.25 | $3.81 | $3.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.56 / $2.56
| Professional | | $2.56 | $2.56 | $2.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.52 / $24.87 / $36.04
| Facility | | $18.52 | $24.87 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.05 / $4.05 / $4.26
| Professional | | $4.05 | $4.05 | $4.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.78 / $2.98 / $6.97
| Facility | | $2.78 | $2.98 | $6.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.87 / $4.24 / $6.20
| Professional | | $1.87 | $4.24 | $6.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.87 / $3.87 / $70.00
| Facility | | $3.87 | $3.87 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $3.12 / $6.11
| Professional | | $2.56 | $3.12 | $6.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.46 / $18.46 / $26.40
| Facility | | $18.46 | $18.46 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.85 / $4.26
| Professional | | $2.56 | $2.85 | $4.26 |