- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.52 / $1.52 / $1.52
| Facility | | $1.52 | $1.52 | $1.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $1.52 / $1.52
| Professional | | $1.27 | $1.52 | $1.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.17 / $1.28
| Professional | | $1.12 | $1.17 | $1.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.39 / $2.29 / $2.58
| Facility | | $1.39 | $2.29 | $2.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.30 / $1.43
| Professional | | $1.20 | $1.30 | $1.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.17 / $1.21 / $1.28
| Facility | | $1.17 | $1.21 | $1.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.03 / $1.03 / $2.81
| Professional | | $1.03 | $1.03 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.55 / $1.52 / $2.06
| Facility | | $0.55 | $1.52 | $2.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.32
| Professional | | $1.00 | $1.00 | $1.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $3.70
| Professional | | $2.40 | $2.40 | $3.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.66 / $0.85 / $1.28
| Professional | | $0.66 | $0.85 | $1.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $80.00 / $80.00
| Facility | | $75.00 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $9.86 / $14.85
| Professional | | $9.86 | $9.86 | $14.85 |