- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.14 / $37.31 / $116.48
| Facility | | $10.14 | $37.31 | $116.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $7.03 / $10.62
| Professional | | $6.46 | $7.03 | $10.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $4.84 / $4.84
| Professional | | $4.84 | $4.84 | $4.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.58 / $11.95 / $66.09
| Facility | | $5.58 | $11.95 | $66.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $5.95 / $6.22
| Professional | | $3.50 | $5.95 | $6.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.44 / $19.62 / $37.22
| Facility | | $8.44 | $19.62 | $37.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.28 / $9.91 / $12.41
| Professional | | $5.28 | $9.91 | $12.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.22 / $14.14 / $89.67
| Professional | | $8.22 | $14.14 | $89.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $10.50 / $10.50
| Professional | | $10.50 | $10.50 | $10.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.04 / $5.54 / $10.10
| Professional | | $4.04 | $5.54 | $10.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.28 / $4.84 / $8.32
| Professional | | $3.28 | $4.84 | $8.32 |