- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.55 / $41.60 / $201.52
| Facility | | $28.55 | $41.60 | $201.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.57 / $15.86 / $24.00
| Professional | | $11.57 | $15.86 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.00 / $13.04 / $48.00
| Facility | | $12.00 | $13.04 | $48.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.45 / $14.04 / $17.55
| Professional | | $7.45 | $14.04 | $17.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.57 / $20.32 / $25.44
| Facility | | $11.57 | $20.32 | $25.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $12.31 / $14.77
| Professional | | $12.31 | $12.31 | $14.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $12.31 / $12.31
| Professional | | $12.31 | $12.31 | $12.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.47 / $27.70 / $45.30
| Facility | | $18.47 | $27.70 | $45.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $20.95 / $21.66
| Professional | | $10.46 | $20.95 | $21.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.39 / $10.24 / $19.84
| Professional | | $7.39 | $10.24 | $19.84 |