- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.75 / $3.75 / $5.52
| Facility | | $3.75 | $3.75 | $5.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $2.67 / $5.52
| Professional | | $1.37 | $2.67 | $5.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $3.50 / $3.50
| Professional | | $3.00 | $3.50 | $3.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.01 / $6.28 / $6.68
| Facility | | $6.01 | $6.28 | $6.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.97 / $5.97 / $5.97
| Professional | | $5.97 | $5.97 | $5.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $3.01 / $3.01
| Facility | | $3.01 | $3.01 | $3.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.56 / $7.03
| Professional | | $2.56 | $2.56 | $7.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.37 / $4.32 / $80.00
| Facility | | $1.37 | $4.32 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $2.50 / $6.39
| Professional | | $1.42 | $2.50 | $6.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.42 / $2.25 / $3.20
| Professional | | $1.42 | $2.25 | $3.20 |