- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.28 / $39.47 / $273.77
| Facility | | $15.28 | $39.47 | $273.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $12.67 / $25.16
| Professional | | $10.19 | $12.67 | $25.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.73 / $8.73 / $8.73
| Professional | | $8.73 | $8.73 | $8.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.48 / $14.55 / $18.19
| Facility | | $6.48 | $14.55 | $18.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.18 / $8.80 / $11.17
| Professional | | $7.18 | $8.80 | $11.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.46 / $17.03 / $52.69
| Facility | | $9.46 | $17.03 | $52.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $16.93 / $21.17
| Professional | | $10.98 | $16.93 | $21.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.18 / $14.55 / $15.28
| Professional | | $0.18 | $14.55 | $15.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $5.00
| Professional | | $5.00 | $5.00 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.11 / $8.53 / $20.32
| Professional | | $6.11 | $8.53 | $20.32 |