- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.55 / $13.03 / $118.39
| Facility | | $10.55 | $13.03 | $118.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.55 / $10.55 / $17.89
| Professional | | $10.55 | $10.55 | $17.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.61 / $17.39 / $105.57
| Facility | | $12.61 | $17.39 | $105.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.21 / $5.21 / $13.06
| Professional | | $5.21 | $5.21 | $13.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.29 / $18.28 / $23.89
| Facility | | $14.29 | $18.28 | $23.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.09 / $14.87 / $18.88
| Professional | | $13.09 | $14.87 | $18.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $13.03 / $15.78
| Professional | | $13.03 | $13.03 | $15.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.66 / $13.03 / $118.39
| Facility | | $12.66 | $13.03 | $118.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.55 / $13.03 / $15.07
| Professional | | $10.55 | $13.03 | $15.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $8.52 / $20.60
| Professional | | $7.82 | $8.52 | $20.60 |