- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.71 / $2.02 / $6.29
| Professional | | $0.71 | $2.02 | $6.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $3.00 / $3.75
| Professional | | $2.62 | $3.00 | $3.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $2.70 / $4.43
| Professional | | $2.45 | $2.70 | $4.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.68 / $2.60 / $3.23
| Facility | | $1.68 | $2.60 | $3.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.56 / $6.32
| Professional | | $1.20 | $1.56 | $6.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.44 / $2.70 / $3.52
| Facility | | $2.44 | $2.70 | $3.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.17 / $2.80 / $4.03
| Professional | | $2.17 | $2.80 | $4.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.10 / $3.70 / $4.80
| Professional | | $3.10 | $3.70 | $4.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.22 / $5.08
| Professional | | $1.20 | $1.22 | $5.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.21 / $2.21 / $2.21
| Facility | | $2.21 | $2.21 | $2.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.75 / $2.21 / $2.21
| Professional | | $1.75 | $2.21 | $2.21 |