- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $2.31 / $3.37
| Professional | | $1.12 | $2.31 | $3.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.02 / $3.67 / $6.64
| Facility | | $1.02 | $3.67 | $6.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $3.39 / $4.62
| Professional | | $2.54 | $3.39 | $4.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.31 / $2.31 / $2.31
| Facility | | $2.31 | $2.31 | $2.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $1.96 / $2.72
| Professional | | $1.96 | $1.96 | $2.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.05 / $2.75 / $80.00
| Facility | | $1.05 | $2.75 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $1.63 / $2.46
| Professional | | $1.30 | $1.63 | $2.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.48 / $1.63 / $2.34
| Professional | | $1.48 | $1.63 | $2.34 |