- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $1.61 / $1.61
| Facility | | $1.57 | $1.61 | $1.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.75 / $1.60 / $2.10
| Professional | | $0.75 | $1.60 | $2.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.50 / $1.52 / $2.78
| Facility | | $1.50 | $1.52 | $2.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.52 / $2.78 / $3.75
| Professional | | $1.52 | $2.78 | $3.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $2.74 / $3.67
| Professional | | $2.15 | $2.74 | $3.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.73 / $2.90 / $80.00
| Facility | | $1.73 | $2.90 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.31 / $3.32
| Professional | | $1.07 | $1.31 | $3.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.78 / $2.78 / $3.33
| Facility | | $2.78 | $2.78 | $3.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $3.25 / $5.32
| Professional | | $2.19 | $3.25 | $5.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.25 / $427.25 / $427.25
| Facility | | $427.25 | $427.25 | $427.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.27 / $2.17
| Professional | | $1.07 | $1.27 | $2.17 |
- 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
- $1.80 / $2.27 / $2.27
| Professional | | $1.80 | $2.27 | $2.27 |