- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.04 / $14.04 / $14.04
| Facility | | $14.04 | $14.04 | $14.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $3.72 / $17.66
| Professional | | $2.73 | $3.72 | $17.66 |
- 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 / $3.51
| Professional | | $2.98 | $2.98 | $3.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.28 / $12.07 / $15.76
| Professional | | $4.28 | $12.07 | $15.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $5.09 / $6.12
| Facility | | $3.72 | $5.09 | $6.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.55 / $5.81 / $6.43
| Professional | | $4.55 | $5.81 | $6.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.51 / $6.12 / $7.00
| Facility | | $5.51 | $6.12 | $7.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.51 / $4.83 / $6.12
| Facility | | $3.51 | $4.83 | $6.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.98 / $5.36 / $6.73
| Professional | | $2.98 | $5.36 | $6.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.09 / $10.18 / $21.48
| Facility | | $5.09 | $10.18 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $6.73 / $6.73
| Professional | | $5.32 | $6.73 | $6.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $2.80 / $5.37
| Professional | | $2.68 | $2.80 | $5.37 |