- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.48 / $163.21 / $719.76
| Facility | | $15.48 | $163.21 | $719.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $6.74 / $9.31
| Professional | | $6.30 | $6.74 | $9.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.94 / $24.45 / $38.75
| Facility | | $8.94 | $24.45 | $38.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.38 / $5.07 / $7.02
| Professional | | $4.38 | $5.07 | $7.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.95 / $8.09 / $21.78
| Facility | | $4.95 | $8.09 | $21.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $8.44 / $11.87
| Professional | | $5.17 | $8.44 | $11.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.43 / $10.15 / $16.67
| Facility | | $6.43 | $10.15 | $16.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.67 / $11.00 / $22.00
| Professional | | $5.67 | $11.00 | $22.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.65 / $10.65 / $10.65
| Facility | | $10.65 | $10.65 | $10.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $4.87 / $6.26
| Professional | | $3.55 | $4.87 | $6.26 |