- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.63 / $29.29 / $172.48
| Facility | | $17.63 | $29.29 | $172.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $15.26 / $15.37
| Professional | | $9.33 | $15.26 | $15.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.58 / $10.58 / $10.58
| Professional | | $10.58 | $10.58 | $10.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.85 / $17.63 / $22.04
| Facility | | $7.85 | $17.63 | $22.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $10.66 / $13.53
| Professional | | $8.71 | $10.66 | $13.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.46 / $20.63 / $63.83
| Facility | | $11.46 | $20.63 | $63.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.14 / $20.65 / $25.81
| Professional | | $13.14 | $20.65 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.24 / $17.63 / $18.51
| Professional | | $0.24 | $17.63 | $18.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $6.06 / $6.06
| Professional | | $6.06 | $6.06 | $6.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $12.60 / $34.57
| Professional | | $7.40 | $12.60 | $34.57 |