- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $86.18 / $119.41
| Facility | | $5.25 | $86.18 | $119.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.78 / $4.25 / $8.42
| Professional | | $3.78 | $4.25 | $8.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.28 / $3.28 / $3.28
| Professional | | $3.28 | $3.28 | $3.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.85 / $19.73 / $19.73
| Facility | | $9.85 | $19.73 | $19.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.30 / $3.30 / $4.25
| Professional | | $3.30 | $3.30 | $4.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.22 / $5.01 / $12.45
| Facility | | $3.22 | $5.01 | $12.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $3.46 / $7.23
| Professional | | $3.00 | $3.46 | $7.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.78 / $4.29 / $9.25
| Facility | | $3.78 | $4.29 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.28 / $6.77 / $9.00
| Professional | | $4.28 | $6.77 | $9.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $3.23 / $6.45
| Professional | | $2.36 | $3.23 | $6.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.17 / $60.00 / $100.00
| Facility | | $40.17 | $60.00 | $100.00 |