- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.63 / $2.98 / $5.21
| Facility | | $1.63 | $2.98 | $5.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.13 / $3.70 / $3.96
| Professional | | $1.13 | $3.70 | $3.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.51 / $10.09 / $14.63
| Facility | | $7.51 | $10.09 | $14.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.06 / $2.17
| Professional | | $2.06 | $2.06 | $2.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.41 / $1.52 / $3.54
| Facility | | $1.41 | $1.52 | $3.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.01 / $2.12 / $3.10
| Professional | | $1.01 | $2.12 | $3.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.97 / $1.97 / $100.00
| Facility | | $1.97 | $1.97 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.58 / $3.04
| Professional | | $1.30 | $1.58 | $3.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $3.72 / $3.72
| Facility | | $3.72 | $3.72 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.35 / $2.17
| Professional | | $1.30 | $1.35 | $2.17 |