- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.17 / $13.47 / $32.00
| Facility | | $5.17 | $13.47 | $32.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.72 / $5.73
| Professional | | $2.54 | $2.72 | $5.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $2.37
| Professional | | $2.37 | $2.37 | $2.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.02 / $7.98 / $13.29
| Facility | | $2.02 | $7.98 | $13.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $3.06 / $4.37
| Professional | | $2.11 | $3.06 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $5.93 / $10.67
| Facility | | $2.39 | $5.93 | $10.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $4.54 / $5.68
| Professional | | $2.00 | $4.54 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $2.68 / $60.00
| Facility | | $2.65 | $2.68 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $1.76 / $2.77
| Professional | | $1.53 | $1.76 | $2.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $1.76 / $2.91
| Professional | | $1.53 | $1.76 | $2.91 |