- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $2.65
| Facility | | $2.65 | $2.65 | $2.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.12 / $2.20 / $2.65
| Professional | | $2.12 | $2.20 | $2.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.77 / $4.07 / $7.13
| Facility | | $2.77 | $4.07 | $7.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $2.83 / $2.83
| Professional | | $2.25 | $2.83 | $2.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.86 / $8.36 / $10.19
| Facility | | $4.86 | $8.36 | $10.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $3.08 / $3.33
| Professional | | $2.65 | $3.08 | $3.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.19 / $7.63 / $9.58
| Facility | | $4.19 | $7.63 | $9.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.63 / $2.63 / $3.57
| Professional | | $2.63 | $2.63 | $3.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $3.33 / $4.48
| Facility | | $2.65 | $3.33 | $4.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $3.66
| Professional | | $2.65 | $2.65 | $3.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $4.76
| Professional | | $2.65 | $2.65 | $4.76 |