- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.42 / $188.28 / $660.44
| Facility | | $2.42 | $188.28 | $660.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.52 / $7.08 / $9.69
| Professional | | $3.52 | $7.08 | $9.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.00 / $19.13 / $23.56
| Facility | | $18.00 | $19.13 | $23.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $13.02
| Professional | | $3.89 | $3.89 | $13.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.52 / $3.52 / $3.52
| Facility | | $3.52 | $3.52 | $3.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.52 / $3.52 / $11.40
| Professional | | $3.52 | $3.52 | $11.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.19 / $7.08 / $12.54
| Facility | | $4.19 | $7.08 | $12.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.59 / $1.59 / $1.59
| Professional | | $1.59 | $1.59 | $1.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.52 / $3.52 / $4.65
| Professional | | $3.52 | $3.52 | $4.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |