- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.48 / $88.55 / $944.38
| Facility | | $9.48 | $88.55 | $944.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.32 / $20.94 / $24.00
| Professional | | $10.32 | $20.94 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.47 / $10.80 / $12.61
| Facility | | $7.47 | $10.80 | $12.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.92 / $5.92 / $14.40
| Professional | | $5.92 | $5.92 | $14.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.00 / $14.40 / $16.80
| Facility | | $12.00 | $14.40 | $16.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $14.52 / $24.00
| Professional | | $12.00 | $14.52 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.80 / $9.34 / $28.60
| Facility | | $7.80 | $9.34 | $28.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.11 / $13.63 / $78.94
| Professional | | $6.11 | $13.63 | $78.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.60 / $6.60 / $6.60
| Professional | | $6.60 | $6.60 | $6.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $10.07 / $15.48
| Professional | | $5.04 | $10.07 | $15.48 |