- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $3.46 / $13.78
| Professional | | $1.30 | $3.46 | $13.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.86 / $2.86 / $2.86
| Facility | | $2.86 | $2.86 | $2.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $2.43 / $3.37
| Professional | | $2.43 | $2.43 | $3.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $8.52 / $10.41
| Professional | | $3.34 | $8.52 | $10.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.40 / $4.18 / $4.98
| Facility | | $3.40 | $4.18 | $4.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $4.53 / $5.01
| Professional | | $3.54 | $4.53 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.26 / $4.66 / $5.25
| Facility | | $4.26 | $4.66 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.17 / $4.76 / $4.76
| Professional | | $4.17 | $4.76 | $4.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.86 / $4.08 / $4.76
| Facility | | $2.86 | $4.08 | $4.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $4.18 / $5.25
| Professional | | $2.43 | $4.18 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.09 / $5.25 / $5.25
| Professional | | $4.09 | $5.25 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.92 / $2.02 / $3.86
| Professional | | $1.92 | $2.02 | $3.86 |