- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.68 / $203.72 / $461.74
| Facility | | $1.68 | $203.72 | $461.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.62 / $1.68 / $1.73
| Professional | | $1.62 | $1.68 | $1.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.22 / $7.00 / $12.00
| Professional | | $1.22 | $7.00 | $12.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.73 / $1.73 / $1.73
| Facility | | $1.73 | $1.73 | $1.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $1.73 / $1.73
| Professional | | $1.73 | $1.73 | $1.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.80 / $32.03 / $32.03
| Facility | | $30.80 | $32.03 | $32.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.00 / $28.80 / $40.00
| Professional | | $28.00 | $28.80 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $50.00
| Professional | | $40.00 | $40.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.69 / $1.69 / $1.77
| Professional | | $1.69 | $1.69 | $1.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.69 / $1.69 / $1.69
| Professional | | $1.69 | $1.69 | $1.69 |