- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.35 / $23.07 / $81.88
| Facility | | $16.35 | $23.07 | $81.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.32 / $16.35 / $17.62
| Professional | | $15.32 | $16.35 | $17.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.81 / $20.34 / $48.61
| Facility | | $12.81 | $20.34 | $48.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $15.44 / $28.91
| Professional | | $10.46 | $15.44 | $28.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.75 / $6.75 / $9.78
| Facility | | $6.75 | $6.75 | $9.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.35 / $11.35 / $26.43
| Professional | | $11.35 | $11.35 | $26.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $9.08 / $12.48
| Professional | | $2.27 | $9.08 | $12.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.36 / $28.36 / $28.36
| Facility | | $28.36 | $28.36 | $28.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.56 / $11.26 / $60.00
| Professional | | $7.56 | $11.26 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.80 / $11.35 / $11.35
| Professional | | $9.80 | $11.35 | $11.35 |