- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.54 / $4.44 / $4.91
| Facility | | $3.54 | $4.44 | $4.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.37 / $3.54 / $3.54
| Professional | | $3.37 | $3.54 | $3.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.78 / $2.78 / $2.78
| Facility | | $2.78 | $2.78 | $2.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $4.96 / $7.85
| Professional | | $3.02 | $4.96 | $7.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.49 / $10.49 / $10.49
| Facility | | $10.49 | $10.49 | $10.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $4.11 / $6.41
| Professional | | $2.72 | $4.11 | $6.41 |