- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $4.09 / $6.48
| Professional | | $1.30 | $4.09 | $6.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.86 / $2.86 / $3.06
| Facility | | $2.86 | $2.86 | $3.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $2.43 / $3.37
| Professional | | $2.43 | $2.43 | $3.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.30 / $3.29 / $6.48
| Facility | | $1.30 | $3.29 | $6.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.29 / $4.53 / $4.76
| Professional | | $4.29 | $4.53 | $4.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.43 / $4.76 / $8.35
| Professional | | $3.43 | $4.76 | $8.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $3.34 / $5.01
| Professional | | $3.34 | $3.34 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $1.92 / $3.40
| Professional | | $1.85 | $1.92 | $3.40 |