- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $1,288.25 / $1,949.84
| Facility | | $5.01 | $1,288.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.08 / $14.13
| Professional | | $6.03 | $7.08 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $10.72 / $12.30
| Professional | | $5.75 | $10.72 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $10.96
| Facility | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $9.77 / $19.50
| Professional | | $6.17 | $9.77 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $5.37 / $8.51
| Professional | | $3.47 | $5.37 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $7.59 / $14.13
| Professional | | $5.37 | $7.59 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $5.50 / $7.08
| Professional | | $5.50 | $5.50 | $7.08 |