- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.75 / $73.31 / $107.10
| Facility | | $16.75 | $73.31 | $107.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $7.75 / $9.00
| Professional | | $5.03 | $7.75 | $9.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.70 / $9.05 / $11.06
| Facility | | $6.70 | $9.05 | $11.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.70 / $8.38 / $9.05
| Professional | | $6.70 | $8.38 | $9.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.45 / $12.16 / $20.12
| Facility | | $5.45 | $12.16 | $20.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $9.81 / $38.57
| Professional | | $3.80 | $9.81 | $38.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.80 / $34.79 / $102.07
| Facility | | $20.80 | $34.79 | $102.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.70 / $6.70 / $10.19
| Professional | | $6.70 | $6.70 | $10.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.81 / $2.81 / $2.81
| Facility | | $2.81 | $2.81 | $2.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $4.11 / $13.57
| Professional | | $3.02 | $4.11 | $13.57 |