- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.72 / $3.32 / $4.29
| Professional | | $1.72 | $3.32 | $4.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.77 / $3.77 / $3.77
| Facility | | $3.77 | $3.77 | $3.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $3.20 / $3.77
| Professional | | $2.40 | $3.20 | $3.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.11 / $10.64 / $13.02
| Professional | | $4.11 | $10.64 | $13.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.18 / $5.14 / $5.94
| Facility | | $4.18 | $5.14 | $5.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $5.28 / $6.16
| Professional | | $4.30 | $5.28 | $6.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $5.73 / $6.46
| Facility | | $5.25 | $5.73 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $5.87 / $5.87
| Professional | | $5.25 | $5.87 | $5.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.51 / $4.99 / $5.88
| Facility | | $3.51 | $4.99 | $5.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $5.13 / $6.27
| Professional | | $2.40 | $5.13 | $6.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $6.46 / $6.46
| Professional | | $5.05 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $2.48 / $4.74
| Professional | | $2.34 | $2.48 | $4.74 |