- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.60 / $21.51 / $37.11
| Facility | | $13.60 | $21.51 | $37.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.60 / $13.92 / $15.52
| Professional | | $13.60 | $13.92 | $15.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.00 / $16.80 / $73.86
| Facility | | $16.00 | $16.80 | $73.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.92 / $9.76 / $28.90
| Professional | | $5.92 | $9.76 | $28.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.59 / $33.56 / $38.38
| Facility | | $22.59 | $33.56 | $38.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.17 / $18.35 / $22.72
| Professional | | $18.17 | $18.35 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.80 / $20.80 / $76.00
| Facility | | $12.80 | $20.80 | $76.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $9.60 / $18.07
| Professional | | $6.72 | $9.60 | $18.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.00 / $19.20 / $24.00
| Facility | | $16.00 | $19.20 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $9.60 / $19.20
| Professional | | $6.72 | $9.60 | $19.20 |