- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.69 / $50.71 / $231.01
| Facility | | $26.69 | $50.71 | $231.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.34 / $19.29 / $20.82
| Professional | | $13.34 | $19.29 | $20.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.01 / $16.01 / $16.01
| Professional | | $16.01 | $16.01 | $16.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.88 / $26.69 / $33.36
| Facility | | $11.88 | $26.69 | $33.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $16.14 / $19.59
| Professional | | $10.68 | $16.14 | $19.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.35 / $31.23 / $96.64
| Facility | | $17.35 | $31.23 | $96.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.32 / $30.98 / $38.72
| Professional | | $13.32 | $30.98 | $38.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.16 / $26.69 / $28.02
| Professional | | $0.16 | $26.69 | $28.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.12 / $6.12 / $6.12
| Professional | | $6.12 | $6.12 | $6.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $16.01 / $27.08
| Professional | | $10.21 | $16.01 | $27.08 |