- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.15 / $130.24 / $553.62
| Facility | | $10.15 | $130.24 | $553.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $9.73 / $64.08
| Professional | | $9.61 | $9.73 | $64.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.54 / $21.54 / $21.54
| Facility | | $21.54 | $21.54 | $21.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.39 / $19.57 / $24.48
| Professional | | $12.39 | $19.57 | $24.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.35 / $40.95 / $115.44
| Facility | | $10.35 | $40.95 | $115.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $7.56 / $15.10
| Professional | | $6.48 | $7.56 | $15.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.94 / $22.01 / $33.86
| Facility | | $13.94 | $22.01 | $33.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.94 / $24.00 / $30.95
| Professional | | $13.94 | $24.00 | $30.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $25.22 / $29.67
| Professional | | $10.80 | $25.22 | $29.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.54 / $9.72 / $12.96
| Professional | | $4.54 | $9.72 | $12.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Professional | | $10.80 | $10.80 | $10.80 |