- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.82 / $20.48 / $49.25
| Facility | | $13.82 | $20.48 | $49.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.37 / $10.78 / $13.82
| Professional | | $10.37 | $10.78 | $13.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.15 / $13.82 / $17.28
| Facility | | $6.15 | $13.82 | $17.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.92 / $7.32 / $10.14
| Professional | | $5.92 | $7.32 | $10.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.98 / $16.16 / $50.02
| Facility | | $8.98 | $16.16 | $50.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.00 / $16.11 / $20.13
| Professional | | $9.00 | $16.11 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.14 / $13.82 / $14.51
| Professional | | $0.14 | $13.82 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $4.12 / $4.12
| Professional | | $4.12 | $4.12 | $4.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.73 / $20.73 / $20.73
| Facility | | $20.73 | $20.73 | $20.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.80 / $7.04 / $14.01
| Professional | | $5.80 | $7.04 | $14.01 |