- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.75 / $82.19 / $158.76
| Facility | | $16.75 | $82.19 | $158.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $13.40 / $13.40
| Professional | | $3.39 | $13.40 | $13.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.05 / $11.05 / $11.05
| Facility | | $11.05 | $11.05 | $11.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $4.54 / $5.68
| Professional | | $2.72 | $4.54 | $5.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.32 / $3.32 / $3.32
| Facility | | $3.32 | $3.32 | $3.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $4.00 / $16.00
| Professional | | $4.00 | $4.00 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.60 / $9.00 / $57.03
| Professional | | $3.60 | $9.00 | $57.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.32 / $3.32 / $3.32
| Facility | | $3.32 | $3.32 | $3.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.66 / $4.74 / $5.29
| Professional | | $3.66 | $4.74 | $5.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $8.00 / $12.07
| Professional | | $2.29 | $8.00 | $12.07 |