- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $128.82 / $371.54
| Facility | | $10.23 | $128.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.59 / $12.88
| Professional | | $6.03 | $7.59 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $5.89 / $15.49
| Professional | | $3.63 | $5.89 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $67.61 / $128.82
| Facility | | $25.12 | $67.61 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $10.47 / $15.14
| Professional | | $8.71 | $10.47 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $21.88 / $70.79
| Facility | | $5.62 | $21.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $5.37 / $12.30
| Professional | | $3.89 | $5.37 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.76 / $10.00 / $24.55
| Facility | | $6.76 | $10.00 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.76 / $8.71 / $10.23
| Facility | | $7.76 | $8.71 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $5.37 / $12.02
| Professional | | $3.63 | $5.37 | $12.02 |