- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $10.30 / $20.02
| Facility | | $2.27 | $10.30 | $20.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $2.27
| Professional | | $2.27 | $2.27 | $2.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $12.58 / $30.14
| Professional | | $2.42 | $12.58 | $30.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.90 / $5.09 / $10.71
| Facility | | $4.90 | $5.09 | $10.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.72 / $3.30 / $4.13
| Professional | | $1.72 | $3.30 | $4.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.14 / $6.14 / $6.14
| Professional | | $6.14 | $6.14 | $6.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $1.81 / $2.75
| Professional | | $1.27 | $1.81 | $2.75 |