- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.67 / $1.67 / $1.67
| Facility | | $1.67 | $1.67 | $1.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.67 / $1.67 / $2.00
| Professional | | $1.67 | $1.67 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.88 / $1.89 / $2.34
| Professional | | $1.88 | $1.89 | $2.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.31 / $2.86 / $3.38
| Facility | | $2.31 | $2.86 | $3.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.57 / $1.57 / $2.75
| Professional | | $0.57 | $1.57 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.83 / $2.25 / $2.62
| Facility | | $1.83 | $2.25 | $2.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $2.62 / $4.25
| Professional | | $2.10 | $2.62 | $4.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.49 / $1.72 / $2.06
| Professional | | $1.49 | $1.72 | $2.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.53 / $1.53 / $2.75
| Professional | | $0.53 | $1.53 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.04 / $2.04
| Professional | | $2.04 | $2.04 | $2.04 |