- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.00 / $28.07 / $235.20
| Facility | | $13.00 | $28.07 | $235.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.37 / $13.58 / $17.14
| Professional | | $10.37 | $13.58 | $17.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $9.35 / $9.35
| Professional | | $9.35 | $9.35 | $9.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.25 / $18.39 / $53.94
| Facility | | $11.25 | $18.39 | $53.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $7.70 / $27.54
| Professional | | $5.77 | $7.70 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.51 / $15.59 / $24.94
| Facility | | $12.51 | $15.59 | $24.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.48 / $34.29 / $49.02
| Facility | | $15.48 | $34.29 | $49.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.27 / $10.34 / $20.92
| Professional | | $8.27 | $10.34 | $20.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.04 / $20.27 / $46.51
| Professional | | $17.04 | $20.27 | $46.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $10.66 / $28.33
| Professional | | $7.60 | $10.66 | $28.33 |