- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.43 / $45.86 / $252.42
| Facility | | $3.43 | $45.86 | $252.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.43 / $3.57 / $12.78
| Professional | | $3.43 | $3.57 | $12.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $101.75 / $122.10
| Facility | | $12.88 | $101.75 | $122.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $3.47 / $14.15
| Professional | | $3.47 | $3.47 | $14.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Facility | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.36 / $3.57 / $3.57
| Professional | | $3.36 | $3.57 | $3.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.43 / $3.70 / $4.25
| Facility | | $3.43 | $3.70 | $4.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.54 / $31.54 / $31.54
| Professional | | $31.54 | $31.54 | $31.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $4.71
| Professional | | $3.57 | $3.57 | $4.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $120.16
| Facility | | $75.00 | $100.00 | $120.16 |