- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.33 / $2.33 / $2.33
| Facility | | $2.33 | $2.33 | $2.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.33 / $2.33 / $2.77
| Professional | | $2.33 | $2.33 | $2.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $2.72 / $2.75
| Professional | | $2.48 | $2.72 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.99 / $3.09 / $3.64
| Facility | | $1.99 | $3.09 | $3.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.99 / $3.64 / $4.76
| Professional | | $1.99 | $3.64 | $4.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.65 / $3.31 / $80.00
| Facility | | $1.65 | $3.31 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.40 / $2.81
| Professional | | $1.07 | $1.40 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.09 / $3.64 / $4.30
| Facility | | $3.09 | $3.64 | $4.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.80 / $3.78 / $7.04
| Professional | | $2.80 | $3.78 | $7.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.02 / $1.40 / $2.11
| Professional | | $1.02 | $1.40 | $2.11 |