- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.75 / $10.47 / $23.44
| Facility | | $5.75 | $10.47 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $18.62
| Professional | | $3.02 | $3.98 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.75 / $9.12 / $15.85
| Facility | | $5.75 | $9.12 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.98 / $6.61
| Professional | | $2.34 | $3.98 | $6.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.80 / $7.41 / $21.38
| Facility | | $3.80 | $7.41 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $5.75 / $8.32
| Professional | | $3.24 | $5.75 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $4.79 / $7.59
| Professional | | $2.75 | $4.79 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Facility | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.95 / $5.75 / $10.23
| Professional | | $2.95 | $5.75 | $10.23 |