- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.40 / $3.40 / $5.30
| Facility | | $3.40 | $3.40 | $5.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $3.40 / $3.40
| Professional | | $2.94 | $3.40 | $3.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.52 / $2.52 / $2.52
| Facility | | $2.52 | $2.52 | $2.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $2.52 / $3.40
| Professional | | $1.71 | $2.52 | $3.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $4.54 / $12.21
| Professional | | $3.98 | $4.54 | $12.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.23 / $3.40 / $18.45
| Facility | | $3.23 | $3.40 | $18.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.40 / $4.83 / $21.12
| Professional | | $3.40 | $4.83 | $21.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.66 / $2.96 / $30.00
| Professional | | $2.66 | $2.96 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.79 / $3.58 / $3.58
| Facility | | $1.79 | $3.58 | $3.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $8.34 / $11.91
| Professional | | $1.50 | $8.34 | $11.91 |