- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $47.86 / $158.49
| Facility | | $10.23 | $47.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $10.96 / $14.79
| Professional | | $7.94 | $10.96 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $34.67 / $57.54
| Facility | | $15.14 | $34.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $12.02 / $12.02
| Professional | | $5.01 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.46 / $7.76 / $37.15
| Facility | | $6.46 | $7.76 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $11.48 / $16.98
| Professional | | $5.13 | $11.48 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $162.18 / $162.18
| Professional | | $16.98 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $5.37 / $8.91
| Facility | | $5.37 | $5.37 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $5.01 / $8.91
| Professional | | $5.01 | $5.01 | $8.91 |