- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.17 / $12.86 / $218.17
| Facility | | $10.17 | $12.86 | $218.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.17 / $10.55 / $12.87
| Professional | | $10.17 | $10.55 | $12.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.01 / $11.58 / $13.53
| Facility | | $8.01 | $11.58 | $13.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.51 / $6.36 / $12.75
| Professional | | $5.51 | $6.36 | $12.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $18.02 / $21.24
| Facility | | $12.87 | $18.02 | $21.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.77 / $16.73 / $25.74
| Professional | | $13.77 | $16.73 | $25.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.36 / $10.01 / $23.35
| Facility | | $8.36 | $10.01 | $23.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.60 / $14.48 / $75.28
| Professional | | $6.60 | $14.48 | $75.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Professional | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.41 / $10.51 / $17.98
| Professional | | $5.41 | $10.51 | $17.98 |