- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.40 / $6.01 / $19.18
| Facility | | $3.40 | $6.01 | $19.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.40 / $3.53 / $4.71
| Professional | | $3.40 | $3.53 | $4.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.68 / $3.88 / $4.53
| Facility | | $2.68 | $3.88 | $4.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $3.60 / $3.60
| Professional | | $2.13 | $3.60 | $3.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.30 / $6.03 / $7.11
| Facility | | $4.30 | $6.03 | $7.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.61 / $5.60 / $8.61
| Professional | | $4.61 | $5.60 | $8.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.80 / $3.35 / $50.00
| Facility | | $2.80 | $3.35 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $4.96 / $38.57
| Professional | | $2.15 | $4.96 | $38.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $2.37
| Professional | | $2.37 | $2.37 | $2.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $3.61 / $6.01
| Professional | | $1.81 | $3.61 | $6.01 |