- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.68 / $209.44 / $2,756.62
| Facility | | $6.68 | $209.44 | $2,756.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.87 / $2.87 / $2.87
| Professional | | $2.87 | $2.87 | $2.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.06 / $16.71 / $38.22
| Professional | | $3.06 | $16.71 | $38.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.23 / $6.47 / $14.28
| Facility | | $6.23 | $6.47 | $14.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $4.54 / $5.68
| Professional | | $2.10 | $4.54 | $5.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.79 / $7.79 / $7.79
| Professional | | $7.79 | $7.79 | $7.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.72 / $2.58 / $3.49
| Professional | | $1.72 | $2.58 | $3.49 |