- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.02 / $54.75 / $114.33
| Facility | | $10.02 | $54.75 | $114.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.51 / $6.28 / $12.00
| Professional | | $5.51 | $6.28 | $12.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $5.17 / $15.07
| Professional | | $4.30 | $5.17 | $15.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.27 / $18.27 / $27.08
| Facility | | $16.27 | $18.27 | $27.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.06 / $12.40 / $12.40
| Professional | | $9.06 | $12.40 | $12.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.37 / $9.07 / $35.02
| Facility | | $4.37 | $9.07 | $35.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $10.01 / $20.00
| Professional | | $4.08 | $10.01 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.27 / $6.27 / $60.00
| Facility | | $6.27 | $6.27 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $8.61 / $15.40
| Professional | | $5.17 | $8.61 | $15.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.68 / $23.68 / $23.68
| Facility | | $23.68 | $23.68 | $23.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $8.61 / $15.40
| Professional | | $5.17 | $8.61 | $15.40 |