- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.91 / $113.29 / $209.53
| Facility | | $13.91 | $113.29 | $209.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $11.27 / $20.86
| Professional | | $10.84 | $11.27 | $20.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.46 / $18.57 / $115.89
| Facility | | $13.46 | $18.57 | $115.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $5.56 / $13.24
| Professional | | $5.56 | $5.56 | $13.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.27 / $16.79 / $26.26
| Facility | | $14.27 | $16.79 | $26.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.08 / $16.11 / $20.13
| Professional | | $14.08 | $16.11 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.91 / $13.91 / $16.84
| Professional | | $13.91 | $13.91 | $16.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.91 / $92.56 / $196.67
| Facility | | $13.91 | $92.56 | $196.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.10 / $12.22 / $15.21
| Professional | | $11.10 | $12.22 | $15.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.35 / $9.36 / $22.62
| Professional | | $8.35 | $9.36 | $22.62 |