- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.50 / $10.07 / $11.17
| Facility | | $5.50 | $10.07 | $11.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.34 / $6.05 / $10.56
| Professional | | $4.34 | $6.05 | $10.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.36 / $8.36 / $8.36
| Facility | | $8.36 | $8.36 | $8.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $8.36 / $8.36
| Professional | | $8.36 | $8.36 | $8.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.58 / $5.69 / $11.20
| Facility | | $3.58 | $5.69 | $11.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $3.59 / $7.74
| Professional | | $2.54 | $3.59 | $7.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $3.30 / $10.43
| Professional | | $2.31 | $3.30 | $10.43 |