- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $3.01 / $5.01
| Facility | | $3.01 | $3.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.64 / $3.01 / $4.05
| Professional | | $1.64 | $3.01 | $4.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $3.69 / $4.74
| Professional | | $2.81 | $3.69 | $4.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.71 / $6.16
| Professional | | $2.25 | $2.71 | $6.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.50 / $4.74 / $4.74
| Professional | | $4.50 | $4.74 | $4.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.56 / $4.74 / $6.40
| Facility | | $3.56 | $4.74 | $6.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.08 / $4.74 / $10.15
| Professional | | $3.08 | $4.74 | $10.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.60 / $2.85 / $5.56
| Facility | | $2.60 | $2.85 | $5.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $2.42 / $3.94
| Professional | | $2.42 | $2.42 | $3.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.69 / $2.85 / $5.30
| Facility | | $2.69 | $2.85 | $5.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $2.85 / $3.35
| Professional | | $2.42 | $2.85 | $3.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $3.71 / $4.87
| Professional | | $2.70 | $3.71 | $4.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $2.23 / $3.02
| Professional | | $1.51 | $2.23 | $3.02 |