- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.88 / $2.16 / $3.70
| Facility | | $1.88 | $2.16 | $3.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.88 / $4.01
| Professional | | $1.85 | $1.88 | $4.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.74 / $2.61 / $3.70
| Facility | | $1.74 | $2.61 | $3.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.85 / $2.00
| Professional | | $1.85 | $1.85 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $4.25 / $5.09
| Professional | | $1.85 | $4.25 | $5.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.50 / $2.29 / $3.98
| Facility | | $1.50 | $2.29 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.24 / $2.04 / $2.41
| Professional | | $1.24 | $2.04 | $2.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.84 / $2.13 / $5.55
| Facility | | $1.84 | $2.13 | $5.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.74 / $2.61 / $5.45
| Facility | | $1.74 | $2.61 | $5.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.52 / $2.00 / $2.31
| Professional | | $1.52 | $2.00 | $2.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.63 / $2.84 / $6.43
| Facility | | $1.63 | $2.84 | $6.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.85 / $2.22
| Professional | | $1.85 | $1.85 | $2.22 |