- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $223.87 / $5,754.40
| Facility | | $3.63 | $223.87 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.63 / $15.14
| Professional | | $3.02 | $3.63 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $3.80 / $12.59
| Facility | | $3.63 | $3.80 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $4.37 / $6.17
| Professional | | $3.63 | $4.37 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.39 / $3.63 / $3.63
| Facility | | $3.39 | $3.63 | $3.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $3.63 / $4.07
| Professional | | $3.63 | $3.63 | $4.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $5.37 / $64.57
| Facility | | $3.72 | $5.37 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $3.98 / $2,137.96
| Professional | | $3.72 | $3.98 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.80 / $4.57 / $5.01
| Facility | | $3.80 | $4.57 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $3.80 / $4.27
| Professional | | $3.31 | $3.80 | $4.27 |