- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.92 / $23.55 / $35.17
| Facility | | $12.92 | $23.55 | $35.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $13.28 / $13.71
| Professional | | $5.25 | $13.28 | $13.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $15.13 / $20.63
| Professional | | $12.00 | $15.13 | $20.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.52 / $10.29 / $12.72
| Facility | | $6.52 | $10.29 | $12.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $8.75 / $12.19
| Professional | | $5.40 | $8.75 | $12.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.98 / $14.00 / $26.93
| Facility | | $8.98 | $14.00 | $26.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.57 / $11.57 / $3,000.00
| Professional | | $11.57 | $11.57 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.70 / $7.97 / $10.30
| Professional | | $5.70 | $7.97 | $10.30 |