- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.84 / $100.27 / $465.83
| Facility | | $13.84 | $100.27 | $465.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $12.05 / $13.15
| Professional | | $10.38 | $12.05 | $13.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.63 / $40.00 / $63.39
| Facility | | $14.63 | $40.00 | $63.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $5.81 / $11.03
| Professional | | $5.81 | $5.81 | $11.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.10 / $13.23 / $35.64
| Facility | | $8.10 | $13.23 | $35.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $12.65 / $20.13
| Professional | | $8.44 | $12.65 | $20.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.52 / $16.61 / $27.24
| Facility | | $10.52 | $16.61 | $27.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.27 / $17.98 / $51.07
| Professional | | $9.27 | $17.98 | $51.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.39 / $17.39 / $17.39
| Facility | | $17.39 | $17.39 | $17.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $7.97 / $10.24
| Professional | | $5.81 | $7.97 | $10.24 |