- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.59 / $2.31 / $2.43
| Facility | | $1.59 | $2.31 | $2.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.92 / $2.15 / $2.52
| Professional | | $1.92 | $2.15 | $2.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $2.29 / $5.55
| Facility | | $2.13 | $2.29 | $5.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.64
| Professional | | $2.11 | $2.11 | $2.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.99 / $1.99 / $2.11
| Facility | | $1.99 | $1.99 | $2.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.49
| Professional | | $2.11 | $2.11 | $2.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $1.90 / $3.27
| Facility | | $1.48 | $1.90 | $3.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.59 / $1.69 / $411.09
| Professional | | $1.59 | $1.69 | $411.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.11 / $2.50
| Professional | | $2.04 | $2.11 | $2.50 |