- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.48 / $2.48 / $2.48
| Facility | | $2.48 | $2.48 | $2.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.93 / $2.20 / $2.48
| Professional | | $1.93 | $2.20 | $2.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.09 / $3.74 / $4.12
| Professional | | $3.09 | $3.74 | $4.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.87 / $5.87 / $6.75
| Facility | | $5.87 | $5.87 | $6.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $3.79 / $4.69
| Professional | | $3.75 | $3.79 | $4.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.48 / $3.38 / $6.08
| Facility | | $2.48 | $3.38 | $6.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.70 / $3.38
| Professional | | $1.30 | $1.70 | $3.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.42 / $2.60
| Professional | | $1.12 | $1.42 | $2.60 |