- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.41 / $2.41 / $2.75
| Facility | | $2.41 | $2.41 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.11 / $2.40 / $3.18
| Professional | | $1.11 | $2.40 | $3.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $4.16
| Facility | | $2.27 | $2.27 | $4.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $4.16 / $5.63
| Professional | | $2.58 | $4.16 | $5.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $9.43 / $10.69
| Professional | | $3.78 | $9.43 | $10.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.58 / $4.41 / $80.00
| Facility | | $2.58 | $4.41 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.91 / $5.16
| Professional | | $1.47 | $1.91 | $5.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.15 / $4.16 / $4.98
| Facility | | $4.15 | $4.16 | $4.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $4.48 / $7.94
| Professional | | $3.26 | $4.48 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.88 / $4.47
| Professional | | $1.47 | $1.88 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.40 / $3.40 / $3.40
| Facility | | $3.40 | $3.40 | $3.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $3.40 / $3.40
| Professional | | $2.69 | $3.40 | $3.40 |