- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.55 / $2.17 / $3.38
| Professional | | $1.55 | $2.17 | $3.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.42 / $10.03 / $11.88
| Facility | | $7.42 | $10.03 | $11.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.35 / $2.77 / $4.62
| Professional | | $2.35 | $2.77 | $4.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.51 / $3.51 / $3.51
| Facility | | $3.51 | $3.51 | $3.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.98 / $3.51 / $3.51
| Professional | | $2.98 | $3.51 | $3.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.89 / $2.62 / $4.37
| Professional | | $1.89 | $2.62 | $4.37 |