- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.68 / $2.68 / $18.00
| Facility | | $2.68 | $2.68 | $18.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $2.68 / $3.55
| Professional | | $2.34 | $2.68 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $2.27 / $5.49
| Professional | | $1.75 | $2.27 | $5.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.21 / $4.23 / $6.28
| Facility | | $2.21 | $4.23 | $6.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.65 / $5.50 / $9.06
| Professional | | $4.65 | $5.50 | $9.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $1.73 / $1.73
| Professional | | $1.73 | $1.73 | $1.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.96 / $4.96 / $4.96
| Facility | | $4.96 | $4.96 | $4.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $1.73 / $1.73
| Professional | | $1.73 | $1.73 | $1.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.38 / $1.76
| Professional | | $1.07 | $1.38 | $1.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.41 / $2.09 / $3.07
| Professional | | $1.41 | $2.09 | $3.07 |