- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.37 / $1.37 / $2.45
| Facility | | $1.37 | $1.37 | $2.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.85 / $4.50
| Professional | | $1.30 | $1.85 | $4.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.39 / $2.82 / $2.82
| Professional | | $2.39 | $2.82 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.06 / $21.45 / $35.67
| Facility | | $9.06 | $21.45 | $35.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.84 / $1.84 / $1.86
| Professional | | $1.84 | $1.84 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $1.25 / $1.25
| Professional | | $1.25 | $1.25 | $1.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $2.81 / $6.25
| Professional | | $2.08 | $2.81 | $6.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.19 / $3.19 / $3.19
| Professional | | $3.19 | $3.19 | $3.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.25 / $3.33 / $3.68
| Professional | | $0.25 | $3.33 | $3.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.87 / $1.22 / $2.04
| Professional | | $0.87 | $1.22 | $2.04 |