- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.23 / $6,380.06 / $14,391.39
| Facility | | $12.23 | $6,380.06 | $14,391.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.07 / $34.85
| Professional | | $10.54 | $11.07 | $34.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.83 / $18.64 / $20.89
| Facility | | $15.83 | $18.64 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $10.54
| Professional | | $10.54 | $10.54 | $10.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $13.17 / $17.63
| Professional | | $10.54 | $13.17 | $17.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.38 / $28.47 / $38.40
| Facility | | $22.38 | $28.47 | $38.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.59 / $14.29 / $15.04
| Professional | | $11.59 | $14.29 | $15.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $10.54
| Professional | | $10.54 | $10.54 | $10.54 |