- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $4.80
| Facility | | $2.37 | $2.37 | $4.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $2.56
| Professional | | $2.37 | $2.37 | $2.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.94 / $2.73 / $5.18
| Facility | | $1.94 | $2.73 | $5.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.92 / $2.27 / $2.40
| Professional | | $1.92 | $2.27 | $2.40 |
- 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
- $2.46 / $2.73 / $3.10
| Professional | | $2.46 | $2.73 | $3.10 |
- 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
- $2.44 / $2.44 / $3.32
| Professional | | $2.44 | $2.44 | $3.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $3.77 / $4.29
| Facility | | $2.40 | $3.77 | $4.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $3.31
| Professional | | $2.40 | $2.40 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $4.30
| Professional | | $2.37 | $2.37 | $4.30 |