- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.56 / $2.56 / $2.91
| Facility | | $2.56 | $2.56 | $2.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.18 / $2.54 / $3.37
| Professional | | $1.18 | $2.54 | $3.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.41 / $2.41 / $4.41
| Facility | | $2.41 | $2.41 | $4.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $4.41 / $5.63
| Professional | | $2.48 | $4.41 | $5.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.82 / $5.31 / $6.02
| Professional | | $3.82 | $5.31 | $6.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.74 / $4.66 / $80.00
| Facility | | $2.74 | $4.66 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.06 / $5.47
| Professional | | $1.70 | $2.06 | $5.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.40 / $4.41 / $5.54
| Facility | | $4.40 | $4.41 | $5.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.44 / $5.16 / $8.42
| Professional | | $3.44 | $5.16 | $8.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.00 / $4.97
| Professional | | $1.70 | $2.00 | $4.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.81 / $3.81 / $3.81
| Facility | | $3.81 | $3.81 | $3.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.01 / $3.81 / $3.81
| Professional | | $3.01 | $3.81 | $3.81 |