- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.38 / $10.80 / $50.03
| Facility | | $4.38 | $10.80 | $50.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $4.30 / $5.56
| Professional | | $4.13 | $4.30 | $5.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $2.50 / $2.78
| Professional | | $2.50 | $2.50 | $2.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.06 / $5.56 / $5.86
| Professional | | $3.06 | $5.56 | $5.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.61 / $11.68 / $18.05
| Facility | | $3.61 | $11.68 | $18.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $3.65 / $7.74
| Professional | | $2.54 | $3.65 | $7.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.89 / $60.00 / $100.00
| Facility | | $16.89 | $60.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.34 / $6.08
| Professional | | $2.34 | $3.34 | $6.08 |