- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.44 / $2.80 / $2.80
| Facility | | $2.44 | $2.80 | $2.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $2.80 / $4.05
| Professional | | $1.32 | $2.80 | $4.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.32 / $3.42 / $4.74
| Professional | | $3.32 | $3.42 | $4.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $3.01 / $3.01
| Professional | | $2.25 | $3.01 | $3.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.56 / $6.64 / $7.82
| Facility | | $3.56 | $6.64 | $7.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.74 / $5.93 / $7.82
| Professional | | $4.74 | $5.93 | $7.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.69 / $2.85 / $5.56
| Facility | | $2.69 | $2.85 | $5.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $2.62 / $22.94
| Professional | | $2.42 | $2.62 | $22.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.21 / $2.70 / $6.16
| Professional | | $2.21 | $2.70 | $6.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.39 / $2.29 / $3.12
| Professional | | $1.39 | $2.29 | $3.12 |