- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.08 / $23.65 / $92.30
| Facility | | $10.08 | $23.65 | $92.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $11.70 / $15.46
| Professional | | $9.30 | $11.70 | $15.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.06 / $8.06 / $9.33
| Professional | | $8.06 | $8.06 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.74 / $31.89 / $46.21
| Facility | | $23.74 | $31.89 | $46.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.77 / $12.77 / $13.73
| Professional | | $12.77 | $12.77 | $13.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.74 / $9.40 / $21.94
| Facility | | $8.74 | $9.40 | $21.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $13.52 / $19.62
| Professional | | $6.05 | $13.52 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.70 / $11.70 / $77.00
| Facility | | $11.70 | $11.70 | $77.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.64 / $7.74 / $16.80
| Professional | | $5.64 | $7.74 | $16.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.06 / $58.06 / $58.06
| Facility | | $58.06 | $58.06 | $58.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.64 / $6.27 / $11.35
| Professional | | $5.64 | $6.27 | $11.35 |