- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.68 / $4.11 / $4.72
| Facility | | $2.68 | $4.11 | $4.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $4.72 / $6.85
| Professional | | $2.25 | $4.72 | $6.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.70 / $7.70 / $7.70
| Professional | | $7.70 | $7.70 | $7.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.62 / $4.01 / $4.01
| Professional | | $3.62 | $4.01 | $4.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.00 / $9.60 / $13.20
| Facility | | $8.00 | $9.60 | $13.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $10.00 / $12.80
| Professional | | $8.00 | $10.00 | $12.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.80 / $4.80 / $9.36
| Facility | | $4.80 | $4.80 | $9.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $4.94 / $38.70
| Professional | | $4.08 | $4.94 | $38.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.70 / $5.74 / $10.40
| Professional | | $4.70 | $5.74 | $10.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $3.70 / $5.13
| Professional | | $2.62 | $3.70 | $5.13 |