- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.74 / $5.26 / $7.66
| Professional | | $2.74 | $5.26 | $7.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.31 / $8.35 / $15.10
| Facility | | $2.31 | $8.35 | $15.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $7.71 / $10.51
| Professional | | $5.78 | $7.71 | $10.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.26 / $5.26 / $5.26
| Facility | | $5.26 | $5.26 | $5.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $6.19
| Professional | | $4.47 | $4.47 | $6.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $6.28 / $80.00
| Facility | | $2.40 | $6.28 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.96 / $3.71 / $5.60
| Professional | | $2.96 | $3.71 | $5.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.35 / $3.71 / $5.60
| Professional | | $3.35 | $3.71 | $5.60 |