- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.14 / $3.50 / $21.28
| Facility | | $3.14 | $3.50 | $21.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $3.50 / $3.91
| Professional | | $3.50 | $3.50 | $3.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.00 / $10.34 / $16.69
| Facility | | $5.00 | $10.34 | $16.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.49 / $5.50 / $6.66
| Professional | | $4.49 | $5.50 | $6.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.16 / $13.02 / $27.66
| Facility | | $8.16 | $13.02 | $27.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $2.38 / $6.71
| Professional | | $1.97 | $2.38 | $6.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.14 / $4.04 / $7.06
| Facility | | $3.14 | $4.04 | $7.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.46 / $5.00 / $5.34
| Professional | | $3.46 | $5.00 | $5.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $2.47 / $3.56
| Professional | | $2.47 | $2.47 | $3.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $2.69 / $5.39
| Professional | | $1.77 | $2.69 | $5.39 |