- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.00 / $13.20 / $112.80
| Facility | | $4.00 | $13.20 | $112.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.28 / $3.80
| Professional | | $3.20 | $3.28 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.16 / $3.60 / $12.00
| Facility | | $3.16 | $3.60 | $12.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.81 / $1.81 / $2.57
| Professional | | $1.81 | $1.81 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.00 / $4.40 / $5.60
| Facility | | $4.00 | $4.40 | $5.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.60 / $4.20 / $5.40
| Professional | | $2.60 | $4.20 | $5.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.68 / $4.00 / $9.23
| Facility | | $2.68 | $4.00 | $9.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.41 / $4.54 / $8.19
| Professional | | $2.41 | $4.54 | $8.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.00 / $4.00 / $6.98
| Facility | | $4.00 | $4.00 | $6.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $2.40 / $4.00
| Professional | | $1.68 | $2.40 | $4.00 |