- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.00 / $460.38 / $3,770.60
| Facility | | $14.00 | $460.38 | $3,770.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $2.69 / $17.96
| Professional | | $2.59 | $2.69 | $17.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.67 / $5.77 / $17.57
| Facility | | $1.67 | $5.77 | $17.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.59 / $0.59 / $0.74
| Professional | | $0.59 | $0.59 | $0.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $2.75
| Facility | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $2.75
| Professional | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.64 / $2.66 / $5.23
| Facility | | $0.64 | $2.66 | $5.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.58 / $13.58 / $13.58
| Professional | | $13.58 | $13.58 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $2.70 / $2.70
| Professional | | $2.70 | $2.70 | $2.70 |