- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $4.18 / $85.50
| Facility | | $2.27 | $4.18 | $85.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.57
| Professional | | $2.54 | $2.54 | $2.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $1.35 / $2.54
| Professional | | $1.35 | $1.35 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.54
| Facility | | $2.40 | $2.40 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $2.54 / $2.54
| Professional | | $1.67 | $2.54 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $2.54 / $9.86
| Professional | | $2.16 | $2.54 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.84 / $8.01
| Professional | | $2.54 | $2.84 | $8.01 |