- 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
- $1.38 / $1.86 / $2.50
| Professional | | $1.38 | $1.86 | $2.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.78 / $2.78 / $5.37
| Facility | | $2.78 | $2.78 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $2.78 / $3.83
| Professional | | $2.62 | $2.78 | $3.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $3.48 / $8.21
| Facility | | $2.65 | $3.48 | $8.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $3.22 / $8.61
| Professional | | $2.68 | $3.22 | $8.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.75 / $0.75 / $3.67
| Professional | | $0.75 | $0.75 | $3.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.79 / $3.25
| Professional | | $1.30 | $1.79 | $3.25 |