- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.71 / $5.71 / $11.58
| Facility | | $5.71 | $5.71 | $11.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $5.94 / $3,242.40
| Professional | | $5.71 | $5.94 | $3,242.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.96 / $7.64 / $13.82
| Facility | | $5.96 | $7.64 | $13.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $5.79 / $6.12
| Professional | | $4.63 | $5.79 | $6.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.92 / $6.80 / $18.64
| Facility | | $5.92 | $6.80 | $18.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $7.13 / $7.62
| Professional | | $6.06 | $7.13 | $7.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.81 / $5.81 / $6.13
| Facility | | $5.81 | $5.81 | $6.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $6.00 / $6.48
| Professional | | $5.81 | $6.00 | $6.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.28 / $9.72 / $15.38
| Facility | | $5.28 | $9.72 | $15.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.79 / $5.79 / $8.52
| Professional | | $5.79 | $5.79 | $8.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $5.71 / $10.35
| Professional | | $5.71 | $5.71 | $10.35 |