- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $27.25
| Facility | | $2.37 | $2.37 | $27.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $3.43
| Professional | | $2.37 | $2.37 | $3.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $3.74 / $10.15
| Facility | | $1.00 | $3.74 | $10.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $2.46 / $2.66
| Professional | | $1.97 | $2.46 | $2.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.30 / $7.41 / $9.02
| Facility | | $4.30 | $7.41 | $9.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.63 / $2.04 / $2.73
| Professional | | $1.63 | $2.04 | $2.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.71 / $6.76 / $8.48
| Facility | | $3.71 | $6.76 | $8.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $1.61 / $2.48
| Professional | | $1.61 | $1.61 | $2.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.46 / $3.45 / $13.10
| Facility | | $2.46 | $3.45 | $13.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $2.46 / $4.46
| Professional | | $2.46 | $2.46 | $4.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $4.68
| Professional | | $2.37 | $2.37 | $4.68 |