- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.35 / $26.36 / $132.60
| Facility | | $13.35 | $26.36 | $132.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.81 / $13.92 / $15.60
| Professional | | $7.81 | $13.92 | $15.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.32 / $10.32 / $10.32
| Professional | | $10.32 | $10.32 | $10.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.30 / $18.46 / $44.18
| Facility | | $11.30 | $18.46 | $44.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $19.38 / $26.33
| Professional | | $11.36 | $19.38 | $26.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.44 / $52.54 / $84.69
| Facility | | $9.44 | $52.54 | $84.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.48 / $10.31 / $17.19
| Professional | | $8.48 | $10.31 | $17.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.06 / $8.25 / $11.34
| Professional | | $2.06 | $8.25 | $11.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.43 / $7.22 / $22.69
| Professional | | $5.43 | $7.22 | $22.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.90 / $10.31 / $10.31
| Professional | | $8.90 | $10.31 | $10.31 |