- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.93 / $18.93 / $185.73
| Facility | | $9.93 | $18.93 | $185.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $22.94 / $24.00
| Professional | | $11.25 | $22.94 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.95 / $7.95 / $7.95
| Professional | | $7.95 | $7.95 | $7.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.40 / $46.20 / $66.94
| Facility | | $34.40 | $46.20 | $66.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.58 / $12.58 / $13.24
| Professional | | $12.58 | $12.58 | $13.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.61 / $9.25 / $21.63
| Facility | | $8.61 | $9.25 | $21.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.91 / $13.25 / $19.10
| Professional | | $5.91 | $13.25 | $19.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.55 / $11.55 / $83.15
| Facility | | $11.55 | $11.55 | $83.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $7.57 / $16.55
| Professional | | $5.56 | $7.57 | $16.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.54 / $11.92 / $18.07
| Facility | | $6.54 | $11.92 | $18.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $6.18 / $8.61
| Professional | | $5.56 | $6.18 | $8.61 |