- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.74 / $33.88 / $112.65
| Facility | | $10.74 | $33.88 | $112.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.69 / $8.69 / $14.74
| Professional | | $8.69 | $8.69 | $14.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.39 / $14.34 / $108.62
| Facility | | $10.39 | $14.34 | $108.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $4.30 / $12.42
| Professional | | $4.30 | $4.30 | $12.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $14.92 / $22.90
| Facility | | $12.68 | $14.92 | $22.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $14.62 / $15.73
| Professional | | $10.80 | $14.62 | $15.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $13.01
| Professional | | $10.74 | $10.74 | $13.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.74 / $45.58 / $107.06
| Facility | | $10.74 | $45.58 | $107.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.69 / $10.74 / $12.52
| Professional | | $8.69 | $10.74 | $12.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.44 / $8.77 / $21.21
| Professional | | $6.44 | $8.77 | $21.21 |