- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.73 / $37.42 / $170.80
| Facility | | $18.73 | $37.42 | $170.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.84 / $18.73 / $37.74
| Professional | | $13.84 | $18.73 | $37.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $12.49 / $12.49
| Professional | | $12.49 | $12.49 | $12.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.02 / $26.59 / $72.00
| Facility | | $15.02 | $26.59 | $72.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.71 / $10.28 / $41.87
| Professional | | $7.71 | $10.28 | $41.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.53 / $20.81 / $33.29
| Facility | | $13.53 | $20.81 | $33.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.53 / $13.53 / $20.81
| Professional | | $13.53 | $13.53 | $20.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.64 / $45.78 / $63.74
| Facility | | $20.64 | $45.78 | $63.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.83 / $25.19 / $31.49
| Professional | | $12.83 | $25.19 | $31.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.74 / $27.05 / $74.75
| Professional | | $22.74 | $27.05 | $74.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.21 / $17.03 / $37.81
| Professional | | $12.21 | $17.03 | $37.81 |