- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.52 / $2.52 / $3.10
| Facility | | $2.52 | $2.52 | $3.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.86 / $2.52 / $2.52
| Professional | | $0.86 | $2.52 | $2.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.31 / $2.78 / $5.25
| Facility | | $2.31 | $2.78 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.16 / $2.29
| Professional | | $2.00 | $2.16 | $2.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.50 / $1.73 / $2.14
| Facility | | $1.50 | $1.73 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.73 / $3.38
| Professional | | $1.47 | $1.73 | $3.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.79 / $2.52 / $3.31
| Facility | | $0.79 | $2.52 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $2.14
| Professional | | $2.00 | $2.00 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $3.50 / $5.30
| Professional | | $3.50 | $3.50 | $5.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.10 / $1.44 / $2.45
| Professional | | $1.10 | $1.44 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.34 / $14.34 / $21.60
| Professional | | $14.34 | $14.34 | $21.60 |