- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.52 / $56.70 / $74.01
| Facility | | $26.52 | $56.70 | $74.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $17.14 / $26.52
| Professional | | $10.74 | $17.14 | $26.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.15 / $12.11 / $44.58
| Facility | | $11.15 | $12.11 | $44.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $13.22 / $16.52
| Professional | | $7.00 | $13.22 | $16.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.74 / $21.19 / $53.07
| Facility | | $10.74 | $21.19 | $53.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.43 / $11.43 / $13.72
| Professional | | $11.43 | $11.43 | $13.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.43 / $11.43 / $11.43
| Professional | | $11.43 | $11.43 | $11.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.14 / $25.72 / $42.06
| Facility | | $17.14 | $25.72 | $42.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $19.79 / $19.91
| Professional | | $9.72 | $19.79 | $19.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $6.80 / $18.82
| Professional | | $4.80 | $6.80 | $18.82 |