- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.58 / $3.32
| Professional | | $2.52 | $2.58 | $3.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.91 / $68,099.99 / $94,999.99
| Facility | | $2.91 | $68,099.99 | $94,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.91 / $2.91 / $2.91
| Professional | | $2.91 | $2.91 | $2.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.15 / $4.23 / $6.41
| Facility | | $3.15 | $4.23 | $6.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $3.10 / $3.15
| Professional | | $1.53 | $3.10 | $3.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.15 / $3.69 / $6.41
| Facility | | $3.15 | $3.69 | $6.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.95 / $2.17 / $3.15
| Professional | | $1.95 | $2.17 | $3.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.30 / $2.98
| Professional | | $1.30 | $1.30 | $2.98 |