- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $416.87 / $1,047.13
| Facility | | $10.96 | $416.87 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $8.91 / $12.02
| Professional | | $6.03 | $8.91 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $8.51 / $8.91
| Professional | | $8.13 | $8.51 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.71 / $12.59 / $22.39
| Facility | | $8.71 | $12.59 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.76 / $7.76 / $7.76
| Facility | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $7.24 / $11.22
| Professional | | $5.25 | $7.24 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $102.33
| Professional | | $100.00 | $100.00 | $102.33 |