- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.50 / $2.50 / $2.50
| Facility | | $2.50 | $2.50 | $2.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $1.86 / $2.50
| Professional | | $1.53 | $1.86 | $2.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.61 / $3.61 / $6.97
| Facility | | $3.61 | $3.61 | $6.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.61 / $3.61 / $5.12
| Professional | | $3.61 | $3.61 | $5.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $3.48 / $17.00
| Facility | | $2.39 | $3.48 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $3.22 / $17.85
| Professional | | $2.68 | $3.22 | $17.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $2.47 / $3.48
| Professional | | $1.30 | $2.47 | $3.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.78 / $3.57
| Professional | | $1.30 | $1.78 | $3.57 |