- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.83 / $4.72
| Professional | | $2.75 | $2.83 | $4.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.61 / $5.81 / $10.50
| Facility | | $1.61 | $5.81 | $10.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $5.35 / $7.29
| Professional | | $4.01 | $5.35 | $7.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.51 / $3.51 / $3.51
| Facility | | $3.51 | $3.51 | $3.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.98 / $2.98 / $7.13
| Professional | | $2.98 | $2.98 | $7.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.80 / $4.08 / $80.00
| Facility | | $1.80 | $4.08 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.80 / $4.30
| Professional | | $2.52 | $2.80 | $4.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $2.80 / $4.21
| Professional | | $2.52 | $2.80 | $4.21 |