- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.09 / $10.92 / $10.92
| Facility | | $3.09 | $10.92 | $10.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.78 / $1.49 / $2.50
| Professional | | $0.78 | $1.49 | $2.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $1.35 / $1.35
| Professional | | $1.35 | $1.35 | $1.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.43 / $2.50 / $5.49
| Facility | | $1.43 | $2.50 | $5.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $1.35 / $2.70
| Professional | | $1.35 | $1.35 | $2.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.78 / $2.98 / $4.69
| Facility | | $2.78 | $2.98 | $4.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $2.56 / $2.56
| Professional | | $2.13 | $2.56 | $2.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.97 / $2.59 / $7.03
| Facility | | $1.97 | $2.59 | $7.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.78 / $1.47 / $2.90
| Professional | | $0.78 | $1.47 | $2.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.35 / $2.02 / $3.42
| Professional | | $1.35 | $2.02 | $3.42 |