- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.80 / $37.15 / $555.77
| Facility | | $5.80 | $37.15 | $555.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.08 / $72.00 / $177.45
| Professional | | $9.08 | $72.00 | $177.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.48 / $3.63 / $3.63
| Professional | | $3.48 | $3.63 | $3.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $3.82 / $5.33
| Professional | | $3.63 | $3.82 | $5.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.08 / $5.50 / $16.43
| Facility | | $4.08 | $5.50 | $16.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $4.01 / $7.23
| Professional | | $2.73 | $4.01 | $7.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $3.07 / $7.30
| Professional | | $2.19 | $3.07 | $7.30 |