- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.15 / $25.45 / $267.89
| Facility | | $14.15 | $25.45 | $267.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.78 / $11.65 / $13.05
| Professional | | $9.78 | $11.65 | $13.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $7.83 / $7.83
| Professional | | $7.83 | $7.83 | $7.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.81 / $13.05 / $16.30
| Facility | | $5.81 | $13.05 | $16.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.44 / $7.89 / $10.02
| Professional | | $6.44 | $7.89 | $10.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.48 / $15.26 / $47.23
| Facility | | $8.48 | $15.26 | $47.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $14.87 / $18.59
| Professional | | $9.72 | $14.87 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.11 / $13.05 / $13.70
| Professional | | $0.11 | $13.05 | $13.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.49 / $4.49 / $4.49
| Professional | | $4.49 | $4.49 | $4.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.48 / $7.66 / $13.05
| Professional | | $5.48 | $7.66 | $13.05 |