- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.67 / $12.67 / $31.68
| Facility | | $12.67 | $12.67 | $31.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $10.26 / $12.67
| Professional | | $10.26 | $10.26 | $12.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.26 / $16.91 / $132.36
| Facility | | $12.26 | $16.91 | $132.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.07 / $5.07 / $14.65
| Professional | | $5.07 | $5.07 | $14.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.90 / $17.53 / $27.04
| Facility | | $14.90 | $17.53 | $27.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.77 / $17.23 / $18.18
| Professional | | $12.77 | $17.23 | $18.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $12.67 / $15.34
| Professional | | $12.67 | $12.67 | $15.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.67 / $12.67 / $31.68
| Facility | | $12.67 | $12.67 | $31.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $10.26 / $12.67
| Professional | | $10.26 | $10.26 | $12.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $10.36 / $25.03
| Professional | | $7.60 | $10.36 | $25.03 |