- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.07 / $79.47 / $152.74
| Facility | | $13.07 | $79.47 | $152.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.07 / $13.57 / $16.76
| Professional | | $13.07 | $13.57 | $16.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Professional | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.14 / $57.79 / $156.55
| Facility | | $26.14 | $57.79 | $156.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.50 / $40.00 / $48.51
| Professional | | $22.50 | $40.00 | $48.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.45 / $48.57 / $100.75
| Facility | | $30.45 | $48.57 | $100.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $11.59 / $24.26
| Professional | | $7.72 | $11.59 | $24.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.64 / $17.60 / $29.48
| Facility | | $12.64 | $17.60 | $29.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $21.59 / $28.00
| Professional | | $7.00 | $21.59 | $28.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.22 / $9.22 / $13.27
| Professional | | $9.22 | $9.22 | $13.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $15.41 / $22.01
| Professional | | $10.06 | $15.41 | $22.01 |