- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.95 / $100.01 / $453.88
| Facility | | $2.95 | $100.01 | $453.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $3.18
| Professional | | $2.54 | $2.54 | $3.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.48 / $2.35 / $2.70
| Facility | | $1.48 | $2.35 | $2.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.54
| Professional | | $2.54 | $2.54 | $2.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $1.77 / $4.25
| Professional | | $1.27 | $1.77 | $4.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.79 / $3.44 / $3.62
| Professional | | $2.79 | $3.44 | $3.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $2.54 / $2.54
| Professional | | $2.54 | $2.54 | $2.54 |