- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.61 / $73.27 / $222.38
| Facility | | $21.61 | $73.27 | $222.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $17.53 / $19.63
| Professional | | $10.40 | $17.53 | $19.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $13.63 / $13.63
| Professional | | $11.78 | $13.63 | $13.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.40 / $16.37 / $423.06
| Facility | | $15.40 | $16.37 | $423.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $143.78
| Professional | | $20.72 | $20.72 | $143.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.91 / $25.22 / $109.43
| Facility | | $12.91 | $25.22 | $109.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.01 / $28.39 / $47.00
| Professional | | $12.01 | $28.39 | $47.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.79 / $17.79 / $93.24
| Facility | | $17.79 | $17.79 | $93.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.24 / $14.50 / $40.04
| Professional | | $8.24 | $14.50 | $40.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.24 / $11.78 / $31.41
| Professional | | $8.24 | $11.78 | $31.41 |