- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.05 / $97.76 / $190.80
| Facility | | $10.05 | $97.76 | $190.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $7.63 / $8.74
| Professional | | $6.47 | $7.63 | $8.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.24 / $5.24 / $5.24
| Professional | | $5.24 | $5.24 | $5.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $8.74 / $10.93
| Facility | | $3.89 | $8.74 | $10.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.32 / $5.28 / $6.41
| Professional | | $4.32 | $5.28 | $6.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.68 / $10.22 / $31.64
| Facility | | $5.68 | $10.22 | $31.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $9.91 / $12.39
| Professional | | $6.48 | $9.91 | $12.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $8.74 / $9.18
| Professional | | $0.11 | $8.74 | $9.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.41 / $2.41 / $2.41
| Professional | | $2.41 | $2.41 | $2.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.67 / $5.24 / $13.11
| Professional | | $3.67 | $5.24 | $13.11 |