- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.98 / $65.55 / $142.63
| Facility | | $6.98 | $65.55 | $142.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.28 / $6.77 / $8.86
| Professional | | $5.28 | $6.77 | $8.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $3.89 / $5.39
| Professional | | $2.10 | $3.89 | $5.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.47 / $23.46 / $33.97
| Facility | | $17.47 | $23.46 | $33.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.38 / $7.38 / $7.94
| Professional | | $7.38 | $7.38 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.05 / $5.43 / $12.71
| Facility | | $5.05 | $5.43 | $12.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.57 / $7.95 / $11.36
| Professional | | $4.57 | $7.95 | $11.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.06 / $14.28 / $100.00
| Facility | | $6.06 | $14.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $4.48 / $9.71
| Professional | | $3.26 | $4.48 | $9.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.63 / $2.63 / $48.02
| Facility | | $2.63 | $2.63 | $48.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $3.62 / $5.05
| Professional | | $3.26 | $3.62 | $5.05 |