- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.33 / $10.33 / $46.18
| Facility | | $10.33 | $10.33 | $46.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $8.36 / $13.58
| Professional | | $8.36 | $8.36 | $13.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $13.79 / $107.89
| Facility | | $10.00 | $13.79 | $107.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $4.13 / $11.95
| Professional | | $4.13 | $4.13 | $11.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.37 / $14.55 / $22.02
| Facility | | $12.37 | $14.55 | $22.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $14.06 / $15.03
| Professional | | $10.48 | $14.06 | $15.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.33 / $10.33 / $12.51
| Professional | | $10.33 | $10.33 | $12.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.33 / $10.33 / $46.18
| Facility | | $10.33 | $10.33 | $46.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $10.33 / $13.58
| Professional | | $8.36 | $10.33 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.20 / $8.44 / $20.39
| Professional | | $6.20 | $8.44 | $20.39 |