- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.64 / $2.91 / $2.94
| Facility | | $1.64 | $2.91 | $2.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.97 / $2.91
| Professional | | $1.47 | $1.97 | $2.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $2.31 / $2.87
| Facility | | $1.48 | $2.31 | $2.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.49 / $1.49 / $2.02
| Professional | | $1.49 | $1.49 | $2.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.38 / $1.47 / $1.47
| Facility | | $1.38 | $1.47 | $1.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $3.46
| Professional | | $1.47 | $1.47 | $3.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.75 / $1.97 / $3.81
| Facility | | $1.75 | $1.97 | $3.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.56 / $2.27
| Professional | | $1.47 | $1.56 | $2.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $85.00 / $100.00
| Facility | | $75.00 | $85.00 | $100.00 |