- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.65 / $2.06 / $2.77
| Facility | | $1.65 | $2.06 | $2.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.65 / $2.52 / $3.06
| Professional | | $1.65 | $2.52 | $3.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.47 / $2.47 / $2.64
| Facility | | $2.47 | $2.47 | $2.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $2.10 / $2.10
| Professional | | $2.10 | $2.10 | $2.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.63 / $4.13 / $14.20
| Facility | | $2.63 | $4.13 | $14.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.83 / $2.21 / $3.24
| Professional | | $0.83 | $2.21 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.51 / $5.48
| Professional | | $2.29 | $2.51 | $5.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.57 / $1.81 / $2.14
| Professional | | $1.57 | $1.81 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.29
| Professional | | $2.29 | $2.29 | $2.29 |