- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.00 / $3.08 / $6.00
| Facility | | $3.00 | $3.08 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $3.01 / $3.63
| Professional | | $2.93 | $3.01 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.68 / $6.38 / $12.07
| Facility | | $3.68 | $6.38 | $12.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.83 / $2.83 / $2.98
| Professional | | $2.83 | $2.83 | $2.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $5.37 / $5.37
| Facility | | $5.37 | $5.37 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.84 / $2.84 / $3.99
| Professional | | $2.84 | $2.84 | $3.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.93 / $4.40 / $9.28
| Facility | | $2.93 | $4.40 | $9.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $3.01 / $3.62
| Professional | | $2.93 | $3.01 | $3.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.35 / $3.36 / $3.45
| Professional | | $3.35 | $3.36 | $3.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $3.26 / $3.75
| Professional | | $2.93 | $3.26 | $3.75 |