- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $58.88 / $169.82
| Facility | | $12.02 | $58.88 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $11.22 / $22.39
| Professional | | $8.91 | $11.22 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $8.51 / $8.51
| Professional | | $7.41 | $8.51 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $57.54 / $102.33
| Facility | | $30.90 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $19.95 / $43.65
| Professional | | $12.88 | $19.95 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $31.62 / $100.00
| Facility | | $8.13 | $31.62 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $7.76 / $17.38
| Professional | | $5.62 | $7.76 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $14.45 / $35.48
| Facility | | $9.55 | $14.45 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $12.30 / $14.79
| Facility | | $11.22 | $12.30 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $7.76 / $17.38
| Professional | | $5.25 | $7.76 | $17.38 |