- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.87 / $21.60 / $116.83
| Facility | | $10.87 | $21.60 | $116.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.60 / $11.85 / $12.52
| Professional | | $10.60 | $11.85 | $12.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.25 / $13.25 / $13.25
| Professional | | $13.25 | $13.25 | $13.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $12.10 / $39.75
| Facility | | $10.47 | $12.10 | $39.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.27 / $6.54 / $9.72
| Professional | | $6.27 | $6.54 | $9.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.25 / $15.90 / $17.89
| Facility | | $13.25 | $15.90 | $17.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.25 / $15.24 / $18.78
| Professional | | $13.25 | $15.24 | $18.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.69 / $13.25 / $34.38
| Facility | | $9.69 | $13.25 | $34.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.73 / $15.28 / $33.34
| Professional | | $8.73 | $15.28 | $33.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.57 / $7.95 / $14.56
| Professional | | $5.57 | $7.95 | $14.56 |