- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.14 / $144.43 / $632.78
| Facility | | $52.14 | $144.43 | $632.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.41 / $2.52 / $6.13
| Professional | | $2.41 | $2.52 | $6.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $4.04 / $77.34
| Facility | | $2.27 | $4.04 | $77.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $3.65 / $9.03
| Professional | | $2.50 | $3.65 | $9.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.27 / $2.27 / $2.41
| Facility | | $2.27 | $2.27 | $2.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.41 / $2.41 / $2.41
| Professional | | $2.41 | $2.41 | $2.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.20 / $2.78 / $15.66
| Facility | | $1.20 | $2.78 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.41 / $2.41 / $2.41
| Professional | | $2.41 | $2.41 | $2.41 |