- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.43 / $164.21 / $776.00
| Facility | | $12.43 | $164.21 | $776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $6.94 / $10.42
| Professional | | $6.42 | $6.94 | $10.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.17 / $25.09 / $39.75
| Facility | | $9.17 | $25.09 | $39.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.64 / $3.64 / $7.25
| Professional | | $3.64 | $3.64 | $7.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.08 / $8.28 / $22.33
| Facility | | $5.08 | $8.28 | $22.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $7.94 / $12.39
| Professional | | $5.31 | $7.94 | $12.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.60 / $10.42 / $17.11
| Facility | | $6.60 | $10.42 | $17.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.82 / $11.28 / $23.00
| Professional | | $5.82 | $11.28 | $23.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.92 / $10.92 / $10.92
| Facility | | $10.92 | $10.92 | $10.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.65 / $5.09 / $6.42
| Professional | | $3.65 | $5.09 | $6.42 |