- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $10.68 / $10.68
| Professional | | $2.58 | $10.68 | $10.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.57 / $5.57 / $5.97
| Facility | | $5.57 | $5.57 | $5.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.73 / $4.73 / $6.36
| Professional | | $4.73 | $4.73 | $6.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $7.88 / $10.68
| Facility | | $2.54 | $7.88 | $10.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.34 / $7.75 / $7.88
| Professional | | $7.34 | $7.75 | $7.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.67 / $7.88 / $13.79
| Professional | | $5.67 | $7.88 | $13.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.52 / $5.75 / $8.27
| Professional | | $5.52 | $5.75 | $8.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.60 / $3.74 / $5.92
| Professional | | $3.60 | $3.74 | $5.92 |