- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.34 / $32.84 / $79.76
| Facility | | $14.34 | $32.84 | $79.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.38 / $46.86 / $127.84
| Professional | | $15.38 | $46.86 | $127.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.46 / $12.46 / $12.46
| Professional | | $12.46 | $12.46 | $12.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.38 / $53.62 / $60.50
| Facility | | $30.38 | $53.62 | $60.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $12.55 / $19.09
| Professional | | $10.76 | $12.55 | $19.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.23 / $21.76 / $47.15
| Facility | | $12.23 | $21.76 | $47.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $11.78 / $25.81
| Professional | | $9.77 | $11.78 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.45 / $15.61 / $21.11
| Facility | | $13.45 | $15.61 | $21.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.45 / $22.14 / $22.46
| Professional | | $18.45 | $22.14 | $22.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.97 / $11.07 / $22.14
| Professional | | $8.97 | $11.07 | $22.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.93 / $85.17 / $100.00
| Facility | | $43.93 | $85.17 | $100.00 |