- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.83 / $409.70 / $1,017.11
| Facility | | $7.83 | $409.70 | $1,017.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $89.87 / $209.30
| Professional | | $13.65 | $89.87 | $209.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.48 / $3.63 / $4.00
| Professional | | $3.48 | $3.63 | $4.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.83 / $17.93 / $20.23
| Facility | | $8.83 | $17.93 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.65 / $5.71
| Professional | | $3.13 | $3.65 | $5.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.56 / $5.51 / $13.34
| Facility | | $3.56 | $5.51 | $13.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.33 / $3.83 / $7.23
| Professional | | $3.33 | $3.83 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.18 / $4.55 / $10.22
| Facility | | $4.18 | $4.55 | $10.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $7.47 / $10.00
| Professional | | $5.40 | $7.47 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $3.56 / $7.12
| Professional | | $2.61 | $3.56 | $7.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.13 / $134.53 / $134.53
| Facility | | $21.13 | $134.53 | $134.53 |