- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $426.58 / $426.58
| Facility | | $12.02 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $12.88 / $22.91
| Professional | | $10.96 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $28.84 / $36.31
| Professional | | $12.59 | $28.84 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $22.39 / $51.29
| Facility | | $18.62 | $22.39 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $23.44
| Professional | | $16.22 | $16.22 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $19.95 / $51.29
| Facility | | $12.30 | $19.95 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $12.02
| Professional | | $8.91 | $8.91 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $30.20
| Professional | | $9.77 | $9.77 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $16.60 / $48.98
| Facility | | $0.02 | $16.60 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $14.13 / $18.62
| Professional | | $10.96 | $14.13 | $18.62 |