- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.05 / $13.95 / $87.50
| Facility | | $4.05 | $13.95 | $87.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.41 / $3.96 / $7.46
| Professional | | $3.41 | $3.96 | $7.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.20 / $2.64 / $3.00
| Professional | | $2.20 | $2.64 | $3.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.18 / $5.62 / $15.22
| Facility | | $3.18 | $5.62 | $15.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.63 / $2.18 / $8.83
| Professional | | $1.63 | $2.18 | $8.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.86 / $4.40 / $7.04
| Facility | | $2.86 | $4.40 | $7.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.86 / $2.86 / $4.40
| Professional | | $2.86 | $2.86 | $4.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.51 / $9.68 / $13.89
| Facility | | $4.51 | $9.68 | $13.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $5.37 / $6.71
| Professional | | $2.75 | $5.37 | $6.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $5.72 / $15.84
| Professional | | $4.80 | $5.72 | $15.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,164.00 / $2,334.62 / $3,659.84
| Facility | | $2,164.00 | $2,334.62 | $3,659.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.98 / $3.22 / $7.21
| Professional | | $1.98 | $3.22 | $7.21 |