- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.98 / $27.07 / $277.29
| Facility | | $10.98 | $27.07 | $277.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $7.84 / $12.07
| Professional | | $6.72 | $7.84 | $12.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.56 / $18.28 / $22.85
| Professional | | $11.56 | $18.28 | $22.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.18 / $15.59 / $56.74
| Professional | | $10.18 | $15.59 | $56.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.18 / $13.23 / $33.71
| Facility | | $10.18 | $13.23 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $10.18 / $26.00
| Professional | | $5.42 | $10.18 | $26.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.47 / $18.30 / $27.72
| Facility | | $12.47 | $18.30 | $27.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.22 / $20.74 / $26.57
| Professional | | $12.22 | $20.74 | $26.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.59 / $6.11 / $20.92
| Professional | | $5.59 | $6.11 | $20.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.03 / $10.18 / $10.18
| Professional | | $8.03 | $10.18 | $10.18 |