- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $15.22 / $117.24
| Facility | | $12.59 | $15.22 | $117.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.18 / $14.03 / $14.28
| Professional | | $12.18 | $14.03 | $14.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.67 / $54.06 / $61.03
| Facility | | $26.67 | $54.06 | $61.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $11.02 / $14.29
| Professional | | $9.44 | $11.02 | $14.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.74 / $16.64 / $40.92
| Facility | | $10.74 | $16.64 | $40.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.98 / $11.67 / $22.72
| Professional | | $9.98 | $11.67 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $14.27 / $30.79
| Facility | | $12.59 | $14.27 | $30.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.44 / $22.54 / $29.00
| Professional | | $21.44 | $22.54 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.87 / $10.80 / $21.47
| Professional | | $7.87 | $10.80 | $21.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.53 / $75.48 / $100.00
| Facility | | $53.53 | $75.48 | $100.00 |