- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.19 / $18.38 / $36.75
| Facility | | $9.19 | $18.38 | $36.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $12.22 / $16.82
| Professional | | $10.70 | $12.22 | $16.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.05 / $81.14 / $131.75
| Facility | | $22.05 | $81.14 | $131.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.02 / $10.02 / $11.52
| Professional | | $10.02 | $10.02 | $11.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.96 / $7.96 / $7.96
| Facility | | $7.96 | $7.96 | $7.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $14.04 / $22.69
| Professional | | $7.48 | $14.04 | $22.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.74 / $6.74 / $6.74
| Professional | | $6.74 | $6.74 | $6.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $14.70 / $23.46
| Facility | | $10.68 | $14.70 | $23.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $12.25 / $22.69
| Professional | | $12.25 | $12.25 | $22.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.15 / $7.22 / $7.36
| Professional | | $5.15 | $7.22 | $7.36 |