- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.73 / $51.31 / $196.42
| Facility | | $13.73 | $51.31 | $196.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.73 / $15.29 / $30.86
| Professional | | $13.73 | $15.29 | $30.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.92 / $11.92 / $11.92
| Professional | | $11.92 | $11.92 | $11.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.06 / $35.79 / $49.85
| Facility | | $29.06 | $35.79 | $49.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $12.01
| Professional | | $10.30 | $10.30 | $12.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.71 / $18.14 / $45.37
| Facility | | $11.71 | $18.14 | $45.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.82 / $12.58 / $24.78
| Professional | | $10.82 | $12.58 | $24.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.72 / $15.55 / $28.39
| Facility | | $13.72 | $15.55 | $28.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.77 / $20.79 / $27.00
| Professional | | $19.77 | $20.79 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $10.30 / $19.80
| Professional | | $8.32 | $10.30 | $19.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.04 / $103.00 / $103.00
| Facility | | $42.04 | $103.00 | $103.00 |