- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.02 / $130.88 / $374.50
| Facility | | $14.02 | $130.88 | $374.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $5.84 / $7.71
| Professional | | $5.03 | $5.84 | $7.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $4.01 / $4.01
| Professional | | $4.01 | $4.01 | $4.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.98 / $6.70 / $8.38
| Facility | | $2.98 | $6.70 | $8.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $4.05 / $5.14
| Professional | | $3.31 | $4.05 | $5.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.36 / $7.85 / $24.29
| Facility | | $4.36 | $7.85 | $24.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $7.85 / $9.81
| Professional | | $5.04 | $7.85 | $9.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.08 / $6.70 / $7.04
| Professional | | $0.08 | $6.70 | $7.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.29 / $2.29
| Professional | | $2.29 | $2.29 | $2.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $6.70 / $30.00
| Professional | | $2.81 | $6.70 | $30.00 |