- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $69.18 / $436.52
| Facility | | $5.62 | $69.18 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.34 / $8.13
| Professional | | $2.00 | $2.34 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $2.40 / $2.40
| Professional | | $2.04 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $2.40 / $2.40
| Facility | | $2.24 | $2.40 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.57
| Professional | | $2.40 | $2.40 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.93 / $2.40 / $2.40
| Facility | | $0.93 | $2.40 | $2.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.51 / $2.51
| Professional | | $2.40 | $2.51 | $2.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.82 / $3.80 / $4.07
| Facility | | $2.82 | $3.80 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.40 / $2.51
| Professional | | $2.29 | $2.40 | $2.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |