- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.33 / $4.00 / $11.10
| Facility | | $2.33 | $4.00 | $11.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $2.33 / $2.52
| Professional | | $2.06 | $2.33 | $2.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.74 / $2.70 / $8.42
| Facility | | $1.74 | $2.70 | $8.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $2.81 / $5.16
| Professional | | $1.68 | $2.81 | $5.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.49 / $14.27 / $23.00
| Facility | | $2.49 | $14.27 | $23.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $1.97 / $3.89
| Professional | | $1.97 | $1.97 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $1.73 / $2.16
| Professional | | $1.58 | $1.73 | $2.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.28 / $3.28 / $4.92
| Facility | | $3.28 | $3.28 | $4.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.14 / $1.51 / $3.50
| Professional | | $1.14 | $1.51 | $3.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $1.97 / $1.97
| Professional | | $1.70 | $1.97 | $1.97 |