- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.47 / $2.47 / $2.52
| Facility | | $2.47 | $2.47 | $2.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.79 / $1.95 / $2.52
| Professional | | $0.79 | $1.95 | $2.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.84 / $1.84 / $2.88
| Professional | | $1.84 | $1.84 | $2.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.73 / $1.73 / $2.14
| Facility | | $1.73 | $1.73 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $1.52 / $2.14
| Professional | | $1.47 | $1.52 | $2.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $2.16 / $4.55
| Professional | | $1.60 | $2.16 | $4.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $1.22 / $2.04
| Professional | | $1.12 | $1.22 | $2.04 |