- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $9.77 / $5,011.87
| Facility | | $3.63 | $9.77 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.63 / $223.87
| Professional | | $3.02 | $3.63 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $5.37 / $10.47
| Facility | | $3.89 | $5.37 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $3.63 / $6.03
| Professional | | $3.63 | $3.63 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.39 / $3.63 / $11.22
| Facility | | $3.39 | $3.63 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $3.63 / $4.68
| Professional | | $3.63 | $3.63 | $4.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $3.98 / $7.41
| Facility | | $3.63 | $3.98 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $3.80 / $4.37
| Professional | | $3.63 | $3.80 | $4.37 |