- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.24 / $4.61 / $5.30
| Facility | | $1.24 | $4.61 | $5.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.24 / $1.24 / $2.08
| Professional | | $1.24 | $1.24 | $2.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.76 / $2.35 / $2.35
| Facility | | $1.76 | $2.35 | $2.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.23 / $2.33 / $2.35
| Professional | | $2.23 | $2.33 | $2.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $2.25 / $2.81
| Professional | | $2.08 | $2.25 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.36 / $2.40 / $100.00
| Facility | | $2.36 | $2.40 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.64
| Professional | | $2.40 | $2.40 | $2.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.55 / $1.66 / $2.65
| Facility | | $1.55 | $1.66 | $2.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.55 / $2.22 / $3.33
| Professional | | $1.55 | $2.22 | $3.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.40 / $2.40
| Professional | | $2.27 | $2.40 | $2.40 |