- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.53 / $5.53 / $45.83
| Facility | | $5.53 | $5.53 | $45.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.59 / $6.10 / $9.85
| Professional | | $4.59 | $6.10 | $9.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.20 / $30.91 / $112.93
| Facility | | $11.20 | $30.91 | $112.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.70 / $9.85 / $9.85
| Professional | | $7.70 | $9.85 | $9.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $4.01 / $10.11
| Professional | | $4.01 | $4.01 | $10.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $13.79 / $29.44
| Professional | | $8.36 | $13.79 | $29.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.81 / $12.81 / $12.81
| Professional | | $12.81 | $12.81 | $12.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.40 / $13.79 / $14.78
| Professional | | $13.40 | $13.79 | $14.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $4.91 / $8.69
| Professional | | $3.75 | $4.91 | $8.69 |