- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.00 / $57.59 / $343.00
| Facility | | $4.00 | $57.59 | $343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $3.48 / $16.00
| Professional | | $2.31 | $3.48 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.55 / $3.48 / $4.34
| Facility | | $1.55 | $3.48 | $4.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.39 / $2.10 / $2.54
| Professional | | $1.39 | $2.10 | $2.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.25 / $4.07 / $12.59
| Facility | | $2.25 | $4.07 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $4.13 / $5.16
| Professional | | $1.97 | $4.13 | $5.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $3.48 / $3.70
| Professional | | $0.02 | $3.48 | $3.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.88 / $0.88 / $0.88
| Professional | | $0.88 | $0.88 | $0.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.75 / $1.75 / $1.75
| Facility | | $1.75 | $1.75 | $1.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.09 / $2.10 / $3.48
| Professional | | $2.09 | $2.10 | $3.48 |