- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.53 / $42.17 / $246.55
| Facility | | $5.53 | $42.17 | $246.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.94 / $5.25 / $5.53
| Professional | | $3.94 | $5.25 | $5.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.75 / $11.75 / $11.75
| Facility | | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $10.44 / $13.06
| Professional | | $6.61 | $10.44 | $13.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.63 / $9.44 / $100.00
| Facility | | $5.63 | $9.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.29 / $12.11
| Professional | | $3.53 | $5.29 | $12.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.59 / $11.99 / $18.43
| Facility | | $7.59 | $11.99 | $18.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $10.11 / $16.63
| Professional | | $7.59 | $10.11 | $16.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $13.73 / $16.14
| Professional | | $9.61 | $13.73 | $16.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $4.12 / $7.06
| Professional | | $2.47 | $4.12 | $7.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.88 / $5.88 / $5.88
| Professional | | $5.88 | $5.88 | $5.88 |