- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.02 / $11.17 / $67.91
| Facility | | $10.02 | $11.17 | $67.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.17 / $11.46 / $12.48
| Professional | | $11.17 | $11.46 | $12.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.50 / $104.67 / $185.87
| Facility | | $39.50 | $104.67 | $185.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $25.00 / $36.00
| Professional | | $14.32 | $25.00 | $36.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.03 / $41.52 / $86.92
| Facility | | $26.03 | $41.52 | $86.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.23 / $9.02 / $20.65
| Professional | | $7.23 | $9.02 | $20.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.17 / $16.54 / $28.01
| Facility | | $11.17 | $16.54 | $28.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $20.51 / $27.00
| Professional | | $16.00 | $20.51 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $7.88 / $11.34
| Professional | | $7.88 | $7.88 | $11.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $9.74 / $20.01
| Professional | | $6.01 | $9.74 | $20.01 |