- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.63 / $61.00 / $256.75
| Facility | | $14.63 | $61.00 | $256.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $10.78 / $20.68
| Professional | | $10.28 | $10.78 | $20.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.09 / $12.69 / $55.81
| Facility | | $12.09 | $12.69 | $55.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $8.86 / $23.80
| Professional | | $4.84 | $8.86 | $23.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.66 / $25.36 / $28.82
| Facility | | $16.66 | $25.36 | $28.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.29 / $5.86 / $17.04
| Professional | | $5.29 | $5.86 | $17.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.50 / $21.04 / $60.00
| Facility | | $10.50 | $21.04 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.08 / $7.25 / $13.66
| Professional | | $5.08 | $7.25 | $13.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.88 / $10.88 / $14.51
| Facility | | $10.88 | $10.88 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.08 / $7.25 / $14.51
| Professional | | $5.08 | $7.25 | $14.51 |