- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.12 / $5.09 / $5.86
| Facility | | $2.12 | $5.09 | $5.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $2.12 / $3.56
| Professional | | $2.12 | $2.12 | $3.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.25 / $3.00 / $3.00
| Facility | | $2.25 | $3.00 | $3.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.85 / $2.97 / $3.00
| Professional | | $2.85 | $2.97 | $3.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.63 / $2.65 / $3.28
| Professional | | $2.63 | $2.65 | $3.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $4.03 / $872.10
| Facility | | $2.65 | $4.03 | $872.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $3.12
| Professional | | $2.65 | $2.65 | $3.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.11 / $3.33 / $4.92
| Facility | | $3.11 | $3.33 | $4.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.11 / $4.36 / $6.68
| Professional | | $3.11 | $4.36 | $6.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.65 / $2.92
| Professional | | $2.52 | $2.65 | $2.92 |