- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.21 / $27.71 / $180.33
| Facility | | $14.21 | $27.71 | $180.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.64 / $16.37 / $21.46
| Professional | | $13.64 | $16.37 | $21.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.76 / $12.76 / $12.76
| Professional | | $12.76 | $12.76 | $12.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.78 / $13.78 / $13.78
| Professional | | $13.78 | $13.78 | $13.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.83 / $40.42 / $84.18
| Facility | | $12.83 | $40.42 | $84.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.76 / $15.05 / $26.33
| Professional | | $11.76 | $15.05 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.35 / $10.10 / $14.70
| Professional | | $7.35 | $10.10 | $14.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.86 / $13,785.00 / $13,785.00
| Facility | | $12.86 | $13,785.00 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.86 / $12.86 / $17.64
| Professional | | $12.86 | $12.86 | $17.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.10 / $10.10 / $10.10
| Facility | | $10.10 | $10.10 | $10.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $11.02 / $25.66
| Professional | | $7.72 | $11.02 | $25.66 |