- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.15 / $58.20 / $403.60
| Facility | | $10.15 | $58.20 | $403.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.44 / $11.65 / $13.05
| Professional | | $10.44 | $11.65 | $13.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $16.30 / $16.30
| Professional | | $16.30 | $16.30 | $16.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.11 / $11.75 / $13.72
| Facility | | $8.11 | $11.75 | $13.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $6.44 / $12.93
| Professional | | $6.17 | $6.44 | $12.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.05 / $15.66 / $18.27
| Facility | | $13.05 | $15.66 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $15.80 / $26.10
| Professional | | $13.05 | $15.80 | $26.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.48 / $10.15 / $27.73
| Facility | | $8.48 | $10.15 | $27.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.60 / $14.87 / $84.46
| Professional | | $6.60 | $14.87 | $84.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.18 / $7.18 / $7.18
| Professional | | $7.18 | $7.18 | $7.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $10.94 / $18.23
| Professional | | $5.25 | $10.94 | $18.23 |