- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $12.40 / $60.08
| Professional | | $10.13 | $12.40 | $60.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.35 / $13.85 / $24.31
| Professional | | $13.35 | $13.85 | $24.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.66 / $15.66 / $15.66
| Facility | | $15.66 | $15.66 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $17.21 / $303.20
| Professional | | $10.11 | $17.21 | $303.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.36 / $22.38 / $22.38
| Professional | | $17.36 | $22.38 | $22.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.36 / $12.49 / $53.67
| Professional | | $10.36 | $12.49 | $53.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $31.10 / $43.80
| Professional | | $27.00 | $31.10 | $43.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.66 / $15.66 / $15.66
| Facility | | $15.66 | $15.66 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $16.37 / $244.89
| Professional | | $10.07 | $16.37 | $244.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.78 / $360.01 / $360.01
| Professional | | $331.78 | $360.01 | $360.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.51 / $14.03 / $205.88
| Professional | | $10.51 | $14.03 | $205.88 |