- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.40 / $6.10 / $21.56
| Facility | | $4.40 | $6.10 | $21.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.65 / $3.78 / $6.16
| Professional | | $3.65 | $3.78 | $6.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.88 / $3.88 / $3.88
| Professional | | $3.88 | $3.88 | $3.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.88 / $6.16 / $8.64
| Facility | | $3.88 | $6.16 | $8.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.15 / $5.15 / $6.93
| Professional | | $5.15 | $5.15 | $6.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.38 / $6.38 / $10.02
| Facility | | $6.38 | $6.38 | $10.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.55 / $5.47 / $5.47
| Professional | | $4.55 | $5.47 | $5.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.88 / $6.16 / $8.81
| Facility | | $3.88 | $6.16 | $8.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.88 / $4.55 / $5.47
| Professional | | $3.88 | $4.55 | $5.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.03 / $5.70 / $11.40
| Professional | | $4.03 | $5.70 | $11.40 |