- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.23 / $3.58 / $9.67
| Facility | | $2.23 | $3.58 | $9.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.58 / $3.58
| Professional | | $3.13 | $3.58 | $3.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.03 / $9.77 / $9.77
| Facility | | $8.03 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.75 / $2.91
| Professional | | $2.00 | $2.75 | $2.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $3.70 / $11.57
| Facility | | $2.24 | $3.70 | $11.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.38 / $6.71
| Professional | | $2.04 | $2.38 | $6.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $3.26 / $5.00
| Facility | | $2.24 | $3.26 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.80 / $3.22 / $5.00
| Professional | | $1.80 | $3.22 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.60 / $2.24 / $4.47
| Professional | | $1.60 | $2.24 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $100.00
| Facility | | $50.00 | $70.00 | $100.00 |