- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $2.42 / $5.35
| Facility | | $2.40 | $2.42 | $5.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.42 / $4.03
| Professional | | $2.40 | $2.42 | $4.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $2.60 / $2.74
| Facility | | $2.06 | $2.60 | $2.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $2.69 / $2.74
| Professional | | $2.58 | $2.69 | $2.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.33 / $2.42 / $2.91
| Professional | | $2.33 | $2.42 | $2.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.17 / $2.40 / $85.00
| Facility | | $2.17 | $2.40 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.40 / $2.64
| Professional | | $2.27 | $2.40 | $2.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.74 / $3.67 / $5.36
| Facility | | $2.74 | $3.67 | $5.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $2.74 / $3.42
| Professional | | $2.50 | $2.74 | $3.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.18 / $2.42 / $2.66
| Professional | | $2.18 | $2.42 | $2.66 |