- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $2.61
| Facility | | $2.61 | $2.61 | $2.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.75 / $3.43
| Professional | | $2.11 | $2.75 | $3.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $2.12 / $2.68
| Professional | | $2.12 | $2.12 | $2.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $3.43 / $7.85
| Professional | | $2.29 | $3.43 | $7.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.64 / $4.12 / $8.05
| Facility | | $3.64 | $4.12 | $8.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.77 / $4.51 / $6.20
| Professional | | $3.77 | $4.51 | $6.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.92 / $2.92 / $3.09
| Facility | | $2.92 | $2.92 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.48 / $2.48 / $5.38
| Professional | | $2.48 | $2.48 | $5.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $4.12 / $7.42
| Professional | | $3.13 | $4.12 | $7.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $2.06 / $3.46
| Professional | | $1.37 | $2.06 | $3.46 |