- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.65 / $53.65 / $83.22
| Facility | | $21.65 | $53.65 | $83.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.86 / $17.82 / $23.42
| Professional | | $11.86 | $17.82 | $23.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.03 / $12.03 / $12.03
| Professional | | $12.03 | $12.03 | $12.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.14 / $22.61 / $75.20
| Facility | | $16.14 | $22.61 | $75.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.51 / $19.22 / $40.18
| Professional | | $11.51 | $19.22 | $40.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.36 / $9.36 / $13.18
| Facility | | $9.36 | $9.36 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.03 / $12.03 / $17.79
| Professional | | $12.03 | $12.03 | $17.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $10.58 / $18.04
| Professional | | $2.65 | $10.58 | $18.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.02 / $8.51 / $33.42
| Professional | | $7.02 | $8.51 | $33.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.03 / $12.03 / $12.03
| Professional | | $12.03 | $12.03 | $12.03 |