- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.03 / $10.07 / $61.23
| Facility | | $9.03 | $10.07 | $61.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $10.07 / $11.23
| Professional | | $10.07 | $10.07 | $11.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.73 / $72.90 / $124.69
| Facility | | $27.73 | $72.90 | $124.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.91 / $17.64 / $30.00
| Professional | | $12.91 | $17.64 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.46 / $37.42 / $77.04
| Facility | | $23.46 | $37.42 | $77.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.08 / $7.49 / $18.59
| Professional | | $6.08 | $7.49 | $18.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.93 / $13.68 / $23.17
| Facility | | $9.93 | $13.68 | $23.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $16.97 / $22.00
| Professional | | $13.00 | $16.97 | $22.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.10 / $7.10 / $10.22
| Professional | | $7.10 | $7.10 | $10.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $7.75 / $16.55
| Professional | | $5.42 | $7.75 | $16.55 |