- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.42 / $16.73 / $152.16
| Facility | | $10.42 | $16.73 | $152.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $12.88 / $16.95
| Professional | | $10.43 | $12.88 | $16.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.46 / $17.19 / $97.23
| Facility | | $12.46 | $17.19 | $97.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.15 / $5.15 / $12.03
| Professional | | $5.15 | $5.15 | $12.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.74 / $17.89 / $21.29
| Facility | | $12.74 | $17.89 | $21.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $14.87 / $18.59
| Professional | | $12.67 | $14.87 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $15.60
| Professional | | $12.88 | $12.88 | $15.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $152.16
| Facility | | $12.88 | $12.88 | $152.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $12.88 / $16.95
| Professional | | $10.43 | $12.88 | $16.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.61 / $7.73 / $19.02
| Professional | | $7.61 | $7.73 | $19.02 |