- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.01 / $48.00 / $483.60
| Facility | | $13.01 | $48.00 | $483.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.32 / $20.94 / $32.13
| Professional | | $10.32 | $20.94 | $32.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.20 / $7.20 / $7.20
| Professional | | $7.20 | $7.20 | $7.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.34 / $12.00 / $15.00
| Facility | | $5.34 | $12.00 | $15.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.92 / $7.26 / $9.21
| Professional | | $5.92 | $7.26 | $9.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.80 / $14.04 / $43.45
| Facility | | $7.80 | $14.04 | $43.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.00 / $13.63 / $17.04
| Professional | | $9.00 | $13.63 | $17.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $12.00 / $12.60
| Professional | | $0.11 | $12.00 | $12.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $4.13 / $4.13
| Professional | | $4.13 | $4.13 | $4.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $7.05 / $16.78
| Professional | | $5.04 | $7.05 | $16.78 |