- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $38.04 / $93.10
| Facility | | $5.62 | $38.04 | $93.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $4.38 / $6.00
| Professional | | $3.34 | $4.38 | $6.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.01 / $3.01 / $3.42
| Professional | | $3.01 | $3.01 | $3.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.71 / $6.41 / $16.48
| Facility | | $3.71 | $6.41 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $3.71 / $10.26
| Professional | | $1.86 | $3.71 | $10.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.26 / $5.01 / $8.02
| Facility | | $3.26 | $5.01 | $8.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $3.26 / $5.01
| Professional | | $3.26 | $3.26 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.16 / $11.04 / $15.68
| Facility | | $5.16 | $11.04 | $15.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $6.20 / $7.75
| Professional | | $3.47 | $6.20 | $7.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.49 / $6.53 / $18.05
| Professional | | $5.49 | $6.53 | $18.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,663.61 / $1,923.50 / $2,164.00
| Facility | | $1,663.61 | $1,923.50 | $2,164.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $3.67 / $8.78
| Professional | | $2.25 | $3.67 | $8.78 |