- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.73 / $2.16 / $2.91
| Facility | | $1.73 | $2.16 | $2.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $2.78 / $3.89
| Professional | | $1.73 | $2.78 | $3.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $2.81 / $2.81
| Professional | | $2.81 | $2.81 | $2.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.67 / $2.67 / $3.30
| Facility | | $2.67 | $2.67 | $3.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $2.86
| Professional | | $2.27 | $2.27 | $2.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.47 / $10.05 / $16.86
| Facility | | $2.47 | $10.05 | $16.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.83 / $2.50 / $3.83
| Professional | | $1.83 | $2.50 | $3.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.45 / $2.24 / $2.46
| Professional | | $1.45 | $2.24 | $2.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $1.88 / $2.44
| Professional | | $1.50 | $1.88 | $2.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $2.24 / $2.86
| Professional | | $2.24 | $2.24 | $2.86 |