- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.53 / $6.53 / $14.81
| Facility | | $3.53 | $6.53 | $14.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $3.71 / $4.18
| Professional | | $3.53 | $3.71 | $4.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $4.70 / $5.03
| Professional | | $2.59 | $4.70 | $5.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.06 / $10.13 / $14.67
| Facility | | $3.06 | $10.13 | $14.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.09 / $2.84 / $7.23
| Professional | | $2.09 | $2.84 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.52 / $70.00 / $100.00
| Facility | | $11.52 | $70.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.71 / $4.70 / $5.22
| Professional | | $2.71 | $4.70 | $5.22 |