- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.58 / $1.58 / $2.81
| Facility | | $1.58 | $1.58 | $2.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.85 / $1.58 / $2.46
| Professional | | $0.85 | $1.58 | $2.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.20 / $5.78 / $24.44
| Facility | | $3.20 | $5.78 | $24.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.14
| Professional | | $2.11 | $2.11 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.44 / $1.44 / $1.86
| Professional | | $1.44 | $1.44 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.39 / $3.23 / $6.81
| Professional | | $2.39 | $3.23 | $6.81 |
- 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
- $3.65 / $3.65 / $3.65
| Professional | | $3.65 | $3.65 | $3.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.08 / $3.82 / $4.22
| Professional | | $1.08 | $3.82 | $4.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.40 / $2.41
| Professional | | $1.00 | $1.40 | $2.41 |