- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.92 / $11.92 / $11.92
| Facility | | $11.92 | $11.92 | $11.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $11.35 / $32.36
| Professional | | $9.09 | $11.35 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $25.83 / $58.35
| Facility | | $12.68 | $25.83 | $58.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $12.68 / $12.68
| Professional | | $10.14 | $12.68 | $12.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.71 / $46.58 / $112.06
| Facility | | $25.71 | $46.58 | $112.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.60 / $18.36 / $24.52
| Professional | | $14.60 | $18.36 | $24.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.46 / $42.59 / $88.24
| Facility | | $25.46 | $42.59 | $88.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.46 / $14.46 / $22.85
| Professional | | $14.46 | $14.46 | $22.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $25.72 / $86.53
| Facility | | $12.68 | $25.72 | $86.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.33 / $10.14 / $27.00
| Professional | | $5.33 | $10.14 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.33 / $10.14 / $27.00
| Professional | | $5.33 | $10.14 | $27.00 |