- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $234.42 / $645.65
| Facility | | $13.49 | $234.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.00 / $3.02
| Professional | | $2.00 | $2.00 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $2.45 / $2.45
| Professional | | $2.45 | $2.45 | $2.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $173.78 / $645.65
| Facility | | $3.89 | $173.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $2.63 / $60.26
| Professional | | $2.00 | $2.63 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.35 / $6.03 / $7.24
| Facility | | $1.35 | $6.03 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.09 / $3.09 / $3.09
| Professional | | $3.09 | $3.09 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $5.62
| Facility | | $3.89 | $3.89 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $2.63 / $60.26
| Professional | | $2.34 | $2.63 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $3.63 / $107.15
| Professional | | $2.29 | $3.63 | $107.15 |