- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.55 / $2.42 / $2.78
| Facility | | $1.55 | $2.42 | $2.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.43 / $2.78 / $4.03
| Professional | | $1.43 | $2.78 | $4.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $2.08 / $2.35
| Professional | | $2.08 | $2.08 | $2.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.40 / $4.76 / $6.64
| Facility | | $3.40 | $4.76 | $6.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.40 / $3.74 / $5.44
| Professional | | $3.40 | $3.74 | $5.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.52 / $5.52 / $5.52
| Facility | | $5.52 | $5.52 | $5.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $6.42
| Professional | | $2.40 | $2.40 | $6.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.74 / $3.31 / $6.12
| Professional | | $2.74 | $3.31 | $6.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.56 / $2.35 / $3.10
| Professional | | $1.56 | $2.35 | $3.10 |