- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $2.86 / $4.18
| Professional | | $1.30 | $2.86 | $4.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.26 / $4.57 / $8.26
| Facility | | $1.26 | $4.57 | $8.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.15 / $4.20 / $5.67
| Professional | | $3.15 | $4.20 | $5.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.86 / $2.86 / $2.86
| Facility | | $2.86 | $2.86 | $2.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $2.43 / $3.37
| Professional | | $2.43 | $2.43 | $3.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.30 / $3.40 / $80.00
| Facility | | $1.30 | $3.40 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.61 / $2.02 / $3.03
| Professional | | $1.61 | $2.02 | $3.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $2.02 / $3.03
| Professional | | $1.71 | $2.02 | $3.03 |