- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.08 / $3.08 / $3.08
| Facility | | $3.08 | $3.08 | $3.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $2.56 / $3.08
| Professional | | $2.46 | $2.56 | $3.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.82 / $10.37 / $19.14
| Facility | | $4.82 | $10.37 | $19.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.04 / $7.55 / $7.65
| Professional | | $6.04 | $7.55 | $7.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.78 / $4.78 / $5.82
| Facility | | $2.78 | $4.78 | $5.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.52 / $1.76 / $1.91
| Professional | | $1.52 | $1.76 | $1.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $4.36 / $5.47
| Facility | | $2.39 | $4.36 | $5.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $1.50 / $2.04
| Professional | | $1.50 | $1.50 | $2.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.28 / $5.18 / $13.16
| Facility | | $1.28 | $5.18 | $13.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $4.63
| Professional | | $2.57 | $2.57 | $4.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $4.66
| Professional | | $2.57 | $2.57 | $4.66 |