- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.65 / $1.65 / $1.89
| Facility | | $1.65 | $1.65 | $1.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.76 / $1.64 / $2.18
| Professional | | $0.76 | $1.64 | $2.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.56 / $1.56 / $2.85
| Facility | | $1.56 | $1.56 | $2.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $2.85 / $3.75
| Professional | | $1.66 | $2.85 | $3.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $2.96 / $7.48
| Professional | | $2.50 | $2.96 | $7.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.77 / $3.03 / $80.00
| Facility | | $1.77 | $3.03 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.01 / $1.31 / $3.55
| Professional | | $1.01 | $1.31 | $3.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.85 / $2.90 / $3.42
| Facility | | $2.85 | $2.90 | $3.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $3.32 / $5.46
| Professional | | $2.24 | $3.32 | $5.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.30 / $3.37
| Professional | | $1.00 | $1.30 | $3.37 |
- 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
- $1.84 / $2.33 / $2.33
| Professional | | $1.84 | $2.33 | $2.33 |