- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.10 / $32.32 / $103.27
| Facility | | $9.10 | $32.32 | $103.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.32 / $25.03 / $25.85
| Professional | | $17.32 | $25.03 | $25.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $16.86 / $18.73
| Professional | | $13.00 | $16.86 | $18.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.02 / $30.17 / $72.26
| Facility | | $19.02 | $30.17 | $72.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.77 / $32.02 / $42.85
| Professional | | $18.77 | $32.02 | $42.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.52 / $103.08 / $166.15
| Facility | | $18.52 | $103.08 | $166.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.08 / $16.86 / $30.64
| Professional | | $15.08 | $16.86 | $30.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.37 / $13.49 / $18.54
| Professional | | $3.37 | $13.49 | $18.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $14.05 / $37.82
| Professional | | $9.84 | $14.05 | $37.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.56 / $16.86 / $16.86
| Professional | | $14.56 | $16.86 | $16.86 |