- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.21 / $2.48 / $8.75
| Facility | | $1.21 | $2.48 | $8.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $2.54 / $4.73
| Professional | | $1.21 | $2.54 | $4.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.54
| Professional | | $2.54 | $2.54 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $4.73 / $6.62
| Facility | | $2.57 | $4.73 | $6.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $5.08
| Professional | | $2.54 | $2.54 | $5.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.69 / $5.88 / $9.24
| Facility | | $2.69 | $5.88 | $9.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $5.04 / $5.04
| Professional | | $4.20 | $5.04 | $5.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $4.73 / $6.76
| Facility | | $2.54 | $4.73 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.40 / $2.54 / $4.20
| Professional | | $1.40 | $2.54 | $4.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $3.81 / $7.62
| Professional | | $2.69 | $3.81 | $7.62 |