- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $8.53 / $17.04
| Facility | | $3.89 | $8.53 | $17.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.86 / $3.84 / $27.46
| Professional | | $2.86 | $3.84 | $27.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.78 / $2.78 / $2.78
| Professional | | $2.78 | $2.78 | $2.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $9.41 / $15.65
| Facility | | $2.39 | $9.41 | $15.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $3.60 / $5.13
| Professional | | $2.48 | $3.60 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.99 / $6.95 / $12.51
| Facility | | $2.99 | $6.95 | $12.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.83 / $5.37 / $6.71
| Professional | | $2.83 | $5.37 | $6.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $3.87 / $70.00
| Facility | | $3.20 | $3.87 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $3.58 / $4.26
| Professional | | $2.56 | $3.58 | $4.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $3.58 / $4.26
| Professional | | $2.56 | $3.58 | $4.26 |