- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.60 / $21.69 / $23.31
| Facility | | $13.60 | $21.69 | $23.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.56 / $21.42 / $21.69
| Professional | | $13.56 | $21.42 | $21.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.55 / $72.51 / $72.51
| Facility | | $56.55 | $72.51 | $72.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.20 / $18.98 / $22.17
| Professional | | $12.20 | $18.98 | $22.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.24 / $22.33 / $71.17
| Facility | | $12.24 | $22.33 | $71.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.42 / $12.58 / $39.24
| Professional | | $11.42 | $12.58 | $39.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.47 / $16.27 / $24.63
| Facility | | $11.47 | $16.27 | $24.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.62 / $24.63 / $24.63
| Professional | | $17.62 | $24.63 | $24.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.20 / $12.32 / $27.11
| Professional | | $12.20 | $12.32 | $27.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $128.77 / $128.77
| Facility | | $50.00 | $128.77 | $128.77 |