- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.85 / $5,412.39 / $13,915.65
| Facility | | $17.85 | $5,412.39 | $13,915.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.65 / $34.85
| Professional | | $10.54 | $10.65 | $34.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $12.12 / $12.12
| Professional | | $12.12 | $12.12 | $12.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.69 / $36.84 / $66.45
| Facility | | $9.69 | $36.84 | $66.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $11.39 / $12.76
| Professional | | $10.11 | $11.39 | $12.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.54
| Facility | | $10.54 | $10.54 | $13.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $10.54
| Professional | | $10.54 | $10.54 | $10.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.09 / $13.54 / $26.03
| Facility | | $11.09 | $13.54 | $26.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $12.12 / $1,253.85
| Professional | | $12.12 | $12.12 | $1,253.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $11.73
| Professional | | $10.54 | $10.54 | $11.73 |