- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.16 / $96.30 / $188.56
| Facility | | $27.16 | $96.30 | $188.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $26.77 / $26.77
| Professional | | $9.61 | $26.77 | $26.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.38 / $14.54 / $53.52
| Facility | | $13.38 | $14.54 | $53.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $15.69 / $19.62
| Professional | | $8.36 | $15.69 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.91 / $23.96 / $28.11
| Facility | | $12.91 | $23.96 | $28.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.73 / $13.73 / $16.48
| Professional | | $13.73 | $13.73 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.73 / $13.73 / $13.73
| Professional | | $13.73 | $13.73 | $13.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.60 / $30.89 / $50.53
| Facility | | $20.60 | $30.89 | $50.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.67 / $23.86 / $24.01
| Professional | | $11.67 | $23.86 | $24.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $8.17 / $22.61
| Professional | | $5.77 | $8.17 | $22.61 |