- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.02 / $47.94 / $141.68
| Facility | | $21.02 | $47.94 | $141.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.21 / $19.41 / $25.13
| Professional | | $15.21 | $19.41 | $25.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.04 / $13.04 / $13.04
| Professional | | $13.04 | $13.04 | $13.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.67 / $21.73 / $27.16
| Facility | | $9.67 | $21.73 | $27.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $13.14 / $16.68
| Professional | | $10.73 | $13.14 | $16.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.12 / $25.42 / $78.65
| Facility | | $14.12 | $25.42 | $78.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.21 / $24.78 / $30.98
| Professional | | $16.21 | $24.78 | $30.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.19 / $21.73 / $22.82
| Professional | | $0.19 | $21.73 | $22.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.47 / $7.47 / $7.47
| Professional | | $7.47 | $7.47 | $7.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.61 / $12.75 / $21.73
| Professional | | $7.61 | $12.75 | $21.73 |