- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.42 / $2.42 / $2.42
| Facility | | $2.42 | $2.42 | $2.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $2.42 / $2.84
| Professional | | $1.70 | $2.42 | $2.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.70 / $2.70
| Professional | | $2.56 | $2.70 | $2.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.47 / $4.95 / $7.52
| Professional | | $0.47 | $4.95 | $7.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.42 / $4.20 / $12.06
| Facility | | $2.42 | $4.20 | $12.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.11 / $1.77 / $24.74
| Professional | | $1.11 | $1.77 | $24.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.65 / $4.37 / $7.52
| Facility | | $3.65 | $4.37 | $7.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.66 / $5.12 / $7.52
| Professional | | $3.66 | $5.12 | $7.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $2.60
| Professional | | $2.00 | $2.00 | $2.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.11 / $1.77 / $2.92
| Professional | | $1.11 | $1.77 | $2.92 |