- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.36 / $2.54 / $3.89
| Professional | | $1.36 | $2.54 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.02 / $3.70 / $6.69
| Facility | | $1.02 | $3.70 | $6.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $3.40 / $4.63
| Professional | | $2.54 | $3.40 | $4.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.67 / $2.67 / $2.67
| Facility | | $2.67 | $2.67 | $2.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $3.41
| Professional | | $2.27 | $2.27 | $3.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.22 / $3.03 / $80.00
| Facility | | $1.22 | $3.03 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $1.88 / $2.84
| Professional | | $1.50 | $1.88 | $2.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.88 / $2.84
| Professional | | $1.48 | $1.88 | $2.84 |