- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.14 / $2.68 / $3.60
| Facility | | $2.14 | $2.68 | $3.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $2.91 / $4.25
| Professional | | $2.14 | $2.91 | $4.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.33 / $4.12
| Professional | | $2.34 | $3.33 | $4.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.92 / $2.92 / $3.09
| Facility | | $2.92 | $2.92 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $2.48 / $3.09
| Professional | | $2.48 | $2.48 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $12.44 / $20.87
| Facility | | $3.07 | $12.44 | $20.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $3.07 / $4.76
| Professional | | $2.54 | $3.07 | $4.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $3.12 / $3.43
| Professional | | $2.02 | $3.12 | $3.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $2.27 / $2.94
| Professional | | $1.74 | $2.27 | $2.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.12 / $3.12 / $3.57
| Professional | | $3.12 | $3.12 | $3.57 |