- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $151.36 / $741.31
| Facility | | $8.13 | $151.36 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $8.51
| Professional | | $2.00 | $2.00 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.78 / $2.04 / $2.57
| Professional | | $1.78 | $2.04 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.29 / $27.54 / $41.69
| Facility | | $2.29 | $27.54 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $3.55 / $9.12
| Professional | | $2.69 | $3.55 | $9.12 |
- 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 / $2.40
| Professional | | $2.40 | $2.40 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.20 / $3.39 / $15.49
| Facility | | $1.20 | $3.39 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.40 / $2.51
| Professional | | $2.29 | $2.40 | $2.51 |