- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.02 / $341.45 / $2,058.26
| Facility | | $7.02 | $341.45 | $2,058.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.01 / $7.02 / $8.40
| Professional | | $7.01 | $7.02 | $8.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.32 / $20.83 / $32.42
| Facility | | $13.32 | $20.83 | $32.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.13 / $6.13 / $6.25
| Facility | | $6.13 | $6.13 | $6.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.27 / $6.25 / $6.25
| Professional | | $5.27 | $6.25 | $6.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.16 / $6.76 / $75.00
| Facility | | $6.16 | $6.76 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $6.50 / $6.50
| Professional | | $6.48 | $6.50 | $6.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.50 / $6.50 / $6.50
| Professional | | $6.50 | $6.50 | $6.50 |