- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.97 / $58.50 / $321.60
| Facility | | $11.97 | $58.50 | $321.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $8.61 / $12.12
| Professional | | $7.40 | $8.61 | $12.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.13 / $27.59 / $43.88
| Facility | | $10.13 | $27.59 | $43.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $4.01 / $7.35
| Professional | | $4.01 | $4.01 | $7.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.61 / $9.16 / $24.67
| Facility | | $5.61 | $9.16 | $24.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.85 / $8.76 / $13.94
| Professional | | $5.85 | $8.76 | $13.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.28 / $11.50 / $18.86
| Facility | | $7.28 | $11.50 | $18.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $12.45 / $26.00
| Professional | | $6.42 | $12.45 | $26.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.03 / $12.03 / $12.03
| Facility | | $12.03 | $12.03 | $12.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $5.62 / $13.37
| Professional | | $4.01 | $5.62 | $13.37 |