- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.29 / $28.10 / $162.44
| Facility | | $11.29 | $28.10 | $162.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.18 / $10.73 / $12.01
| Professional | | $8.18 | $10.73 | $12.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.61 / $23.42 / $132.00
| Facility | | $12.61 | $23.42 | $132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.93 / $11.29 / $20.75
| Professional | | $5.93 | $11.29 | $20.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.33 / $24.60 / $57.88
| Facility | | $8.33 | $24.60 | $57.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $15.44 / $23.86
| Professional | | $8.44 | $15.44 | $23.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.55 / $11.59 / $12.74
| Professional | | $8.55 | $11.59 | $12.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.01 / $12.61 / $30.75
| Facility | | $12.01 | $12.61 | $30.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.01 / $18.02 / $33.03
| Facility | | $12.01 | $18.02 | $33.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $10.81 / $10.81
| Professional | | $10.81 | $10.81 | $10.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.81 / $19.82 / $33.03
| Facility | | $13.81 | $19.82 | $33.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.01 / $12.01 / $32.34
| Professional | | $9.01 | $12.01 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $5.40 / $13.45
| Professional | | $5.04 | $5.40 | $13.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $5.40 / $6.22
| Professional | | $5.40 | $5.40 | $6.22 |