- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.75 / $48.98 / $263.03
| Facility | | $11.75 | $48.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $13.49 / $316.23
| Professional | | $10.96 | $13.49 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $8.91 / $36.31
| Professional | | $7.59 | $8.91 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $20.42 / $20.42
| Professional | | $10.72 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $36.31 / $57.54
| Facility | | $10.00 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $11.48 / $22.91
| Professional | | $6.92 | $11.48 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $100.00
| Facility | | $81.28 | $81.28 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $13.49
| Professional | | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $10.23 / $15.14
| Facility | | $5.37 | $10.23 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $10.23 / $16.98
| Professional | | $6.31 | $10.23 | $16.98 |