- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $6.68 / $10.57
| Professional | | $2.50 | $6.68 | $10.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $5.50 / $5.50
| Facility | | $5.01 | $5.50 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.68 / $4.68 / $6.28
| Professional | | $4.68 | $4.68 | $6.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.50 / $5.57 / $10.57
| Facility | | $2.50 | $5.57 | $10.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.01 / $7.40 / $7.79
| Professional | | $7.01 | $7.40 | $7.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.61 / $7.79 / $13.63
| Professional | | $5.61 | $7.79 | $13.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.45 / $5.45 / $8.18
| Professional | | $5.45 | $5.45 | $8.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.59 / $3.88 / $6.09
| Professional | | $3.59 | $3.88 | $6.09 |