- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.00 / $29.51 / $47.86
| Facility | | $2.00 | $29.51 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.63 / $2.69 / $10.96
| Professional | | $2.63 | $2.69 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $7.08 / $8.32
| Professional | | $5.37 | $7.08 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.17 / $4.17 / $5.25
| Professional | | $4.17 | $4.17 | $5.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.51 / $5.25 / $12.88
| Facility | | $2.51 | $5.25 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $2.09 / $6.17
| Professional | | $1.51 | $2.09 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.51 / $3.72 / $5.25
| Professional | | $1.51 | $3.72 | $5.25 |