- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.29 / $3.43 / $13.67
| Professional | | $1.29 | $3.43 | $13.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.85 / $2.85 / $2.85
| Facility | | $2.85 | $2.85 | $2.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $2.42 / $3.35
| Professional | | $2.42 | $2.42 | $3.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.84 / $8.52 / $10.41
| Professional | | $2.84 | $8.52 | $10.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.37 / $4.15 / $4.98
| Facility | | $3.37 | $4.15 | $4.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.51 / $4.50 / $4.98
| Professional | | $3.51 | $4.50 | $4.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.74 / $4.63 / $5.21
| Facility | | $3.74 | $4.63 | $5.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $4.74 / $4.74
| Professional | | $4.13 | $4.74 | $4.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.83 / $4.04 / $4.74
| Facility | | $2.83 | $4.04 | $4.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $4.15 / $5.21
| Professional | | $2.42 | $4.15 | $5.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $5.21 / $5.21
| Professional | | $4.08 | $5.21 | $5.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.88 / $2.00 / $3.83
| Professional | | $1.88 | $2.00 | $3.83 |