- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.50 / $2.50 / $4.44
| Facility | | $2.50 | $2.50 | $4.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.94 / $2.58 / $3.89
| Professional | | $1.94 | $2.58 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.71 / $9.52 / $38.89
| Facility | | $4.71 | $9.52 | $38.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.60 / $3.33 / $3.33
| Professional | | $2.60 | $3.33 | $3.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $2.78
| Professional | | $2.27 | $2.27 | $2.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.77 / $5.43 / $9.32
| Professional | | $3.77 | $5.43 | $9.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $5.77 / $5.77
| Professional | | $5.77 | $5.77 | $5.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $6.04 / $6.66
| Professional | | $2.11 | $6.04 | $6.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $2.21 / $3.80
| Professional | | $1.57 | $2.21 | $3.80 |