- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.66 / $3.56 / $6.00
| Facility | | $2.66 | $3.56 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $2.79 / $2.79
| Professional | | $2.66 | $2.79 | $2.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.66 / $5.61 / $9.03
| Facility | | $2.66 | $5.61 | $9.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $2.66 / $2.66
| Professional | | $2.66 | $2.66 | $2.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $3.94 / $5.95
| Professional | | $3.47 | $3.94 | $5.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.50 / $2.50 / $2.65
| Facility | | $2.50 | $2.50 | $2.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $2.65
| Professional | | $2.65 | $2.65 | $2.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $3.19 / $3.37
| Professional | | $2.25 | $3.19 | $3.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.18 / $2.21 / $3.86
| Facility | | $1.18 | $2.21 | $3.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $2.00
| Professional | | $2.00 | $2.00 | $2.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.52 / $2.70 / $3.40
| Facility | | $2.52 | $2.70 | $3.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.70 / $3.40
| Professional | | $2.52 | $2.70 | $3.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $2.66 / $3.34
| Professional | | $2.58 | $2.66 | $3.34 |