- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $20.68 / $120.37
| Facility | | $3.63 | $20.68 | $120.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $5.15 / $37.35
| Professional | | $3.00 | $5.15 | $37.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.20 / $10.40 / $18.12
| Professional | | $7.20 | $10.40 | $18.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.08 / $11.08 / $15.51
| Facility | | $11.08 | $11.08 | $15.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.08 / $11.08 / $14.96
| Professional | | $11.08 | $11.08 | $14.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $12.40 / $17.59
| Professional | | $10.06 | $12.40 | $17.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.64 / $36.65 / $91.37
| Facility | | $13.64 | $36.65 | $91.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.91 / $12.85 / $17.59
| Professional | | $10.91 | $12.85 | $17.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $12.34 / $23.56
| Professional | | $9.30 | $12.34 | $23.56 |