- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.23 / $4.23 / $4.94
| Facility | | $4.23 | $4.23 | $4.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $3.13 / $4.23
| Professional | | $2.29 | $3.13 | $4.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.82 / $3.82 / $3.82
| Professional | | $3.82 | $3.82 | $3.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.38 / $2.38 / $4.59
| Facility | | $2.38 | $2.38 | $4.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.38 / $2.38 / $3.28
| Professional | | $2.38 | $2.38 | $3.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.71 / $5.43 / $7.41
| Facility | | $3.71 | $5.43 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $5.43 / $6.67
| Professional | | $4.20 | $5.43 | $6.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.97 / $2.97 / $3.14
| Facility | | $2.97 | $2.97 | $3.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.97 / $5.05
| Professional | | $2.52 | $2.97 | $5.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.40 / $2.31 / $3.32
| Professional | | $1.40 | $2.31 | $3.32 |