- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.85 / $5.44 / $30.58
| Facility | | $3.85 | $5.44 | $30.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $5.64 / $6.88
| Professional | | $5.44 | $5.64 | $6.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.28 / $6.19 / $7.23
| Facility | | $4.28 | $6.19 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.19 / $5.40 / $6.88
| Professional | | $3.19 | $5.40 | $6.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.88 / $9.63 / $11.35
| Facility | | $6.88 | $9.63 | $11.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.36 / $8.94 / $13.76
| Professional | | $7.36 | $8.94 | $13.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.47 / $5.35 / $50.00
| Facility | | $4.47 | $5.35 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.30 / $7.85 / $33.15
| Professional | | $3.30 | $7.85 | $33.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $3.78 / $3.78
| Professional | | $3.78 | $3.78 | $3.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.89 / $5.42 / $10.67
| Professional | | $2.89 | $5.42 | $10.67 |