- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.57 / $26.60 / $467.57
| Facility | | $10.57 | $26.60 | $467.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.64 / $10.57 / $21.14
| Professional | | $9.64 | $10.57 | $21.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.72 / $16.87 / $20.58
| Facility | | $12.72 | $16.87 | $20.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.87 / $10.87 / $11.48
| Professional | | $10.87 | $10.87 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.64 / $9.64 / $9.64
| Facility | | $9.64 | $9.64 | $9.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.64 / $9.64 / $24.87
| Professional | | $9.64 | $9.64 | $24.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.57 / $11.47 / $27.36
| Facility | | $10.57 | $11.47 | $27.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.36 / $20.36 / $20.36
| Professional | | $20.36 | $20.36 | $20.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.64 / $10.22 / $28.59
| Professional | | $9.64 | $10.22 | $28.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $1,252.36
| Facility | | $75.00 | $100.00 | $1,252.36 |