- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.46 / $14.66 / $47.07
| Facility | | $10.46 | $14.66 | $47.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.01 / $10.46 / $12.11
| Professional | | $9.01 | $10.46 | $12.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.07 / $11.48 / $38.25
| Facility | | $10.07 | $11.48 | $38.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.74 / $5.74 / $9.35
| Professional | | $5.74 | $5.74 | $9.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.75 / $15.30 / $17.21
| Facility | | $12.75 | $15.30 | $17.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.75 / $14.66 / $18.07
| Professional | | $12.75 | $14.66 | $18.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.52 / $12.75 / $30.20
| Facility | | $8.52 | $12.75 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $14.46 / $26.02
| Professional | | $7.66 | $14.46 | $26.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.09 / $166.09 / $166.09
| Facility | | $166.09 | $166.09 | $166.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.36 / $7.65 / $12.75
| Professional | | $5.36 | $7.65 | $12.75 |