- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.80 / $70.06 / $588.33
| Facility | | $10.80 | $70.06 | $588.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $8.75 / $12.61
| Professional | | $8.75 | $8.75 | $12.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.45 / $14.42 / $109.31
| Facility | | $10.45 | $14.42 | $109.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.32 / $4.32 / $12.49
| Professional | | $4.32 | $4.32 | $12.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $14.92 / $23.04
| Facility | | $12.68 | $14.92 | $23.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $14.70 / $15.73
| Professional | | $10.80 | $14.70 | $15.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $10.80 / $13.08
| Professional | | $10.80 | $10.80 | $13.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.80 / $48.28 / $363.21
| Facility | | $10.80 | $48.28 | $363.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $10.80 / $12.61
| Professional | | $8.75 | $10.80 | $12.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $8.83 / $21.33
| Professional | | $6.48 | $8.83 | $21.33 |