- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.47 / $2.83 / $3.25
| Facility | | $1.47 | $2.83 | $3.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $4.03
| Professional | | $1.47 | $1.47 | $4.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.24 / $1.66 / $1.66
| Facility | | $1.24 | $1.66 | $1.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.52 / $1.60 / $1.65
| Professional | | $1.52 | $1.60 | $1.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.28 / $1.47 / $1.59
| Professional | | $1.28 | $1.47 | $1.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.41 / $1.62 / $85.00
| Facility | | $1.41 | $1.62 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.41 / $1.68
| Professional | | $1.26 | $1.41 | $1.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.51 / $2.00 / $3.16
| Facility | | $1.51 | $2.00 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.39 / $1.81 / $3.92
| Professional | | $1.39 | $1.81 | $3.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.47 / $1.75
| Professional | | $1.47 | $1.47 | $1.75 |