- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.76 / $2.81 / $25.78
| Professional | | $2.76 | $2.81 | $25.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.81 / $7.82 / $11.85
| Facility | | $5.81 | $7.82 | $11.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.70 / $5.68 / $5.81
| Professional | | $1.70 | $5.68 | $5.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.43 / $6.82 / $11.85
| Facility | | $3.43 | $6.82 | $11.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.61 / $3.61 / $5.81
| Professional | | $3.61 | $3.61 | $5.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.93 / $2.41 / $4.01
| Professional | | $1.93 | $2.41 | $4.01 |