- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.98 / $10.48 / $495.12
| Facility | | $2.98 | $10.48 | $495.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.26 / $10.26
| Professional | | $10.23 | $10.26 | $10.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $10.11 / $10.78
| Professional | | $10.11 | $10.11 | $10.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Facility | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $12.33
| Professional | | $10.48 | $10.48 | $12.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.26 / $10.88 / $13.56
| Facility | | $10.26 | $10.88 | $13.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.70 / $0.70 / $0.70
| Professional | | $0.70 | $0.70 | $0.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Facility | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $15.92
| Professional | | $10.27 | $10.27 | $15.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |