- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.37 / $47.86 / $588.84
| Facility | | $4.37 | $47.86 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.40 / $7.24
| Professional | | $2.00 | $2.40 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.24 / $3.39 / $4.57
| Facility | | $2.24 | $3.39 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.57
| Professional | | $2.40 | $2.40 | $2.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $5.01 / $6.03
| Professional | | $2.34 | $5.01 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $3.55 / $295.12
| Facility | | $2.40 | $3.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.15 / $2.51 / $3.39
| Professional | | $1.15 | $2.51 | $3.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $3.02 / $5.01
| Facility | | $2.40 | $3.02 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.40 / $3.39 / $7.08
| Facility | | $2.40 | $3.39 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.09 / $2.57 / $79.43
| Professional | | $2.09 | $2.57 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |