- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.43 / $10.28 / $10.28
| Facility | | $3.43 | $10.28 | $10.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $3.81 / $18.00
| Professional | | $3.54 | $3.81 | $18.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.41 / $4.00 / $4.26
| Professional | | $3.41 | $4.00 | $4.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $6.41 / $69.03
| Professional | | $3.54 | $6.41 | $69.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.72 / $6.74 / $16.00
| Facility | | $2.72 | $6.74 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $16.00
| Professional | | $2.27 | $2.27 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.72 / $6.07 / $14.38
| Facility | | $2.72 | $6.07 | $14.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $10.01 / $17.93
| Professional | | $2.72 | $10.01 | $17.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $3.54 / $3.65
| Professional | | $3.54 | $3.54 | $3.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $2.27
| Facility | | $2.27 | $2.27 | $2.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $2.27
| Professional | | $2.27 | $2.27 | $2.27 |