- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.03 / $21.68 / $361.80
| Facility | | $9.03 | $21.68 | $361.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $14.41 / $29.86
| Professional | | $10.50 | $14.41 | $29.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.69 / $79.81 / $129.60
| Facility | | $21.69 | $79.81 | $129.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $9.86 / $11.33
| Professional | | $7.40 | $9.86 | $11.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.83 / $7.83 / $7.83
| Facility | | $7.83 | $7.83 | $7.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.64 / $13.63 / $22.69
| Professional | | $7.64 | $13.63 | $22.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $6.63 / $6.63
| Professional | | $6.63 | $6.63 | $6.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.73 / $14.46 / $23.58
| Facility | | $10.73 | $14.46 | $23.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $12.05 / $22.69
| Professional | | $12.05 | $12.05 | $22.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.85 / $10.85 / $10.85
| Facility | | $10.85 | $10.85 | $10.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $7.17 / $7.39
| Professional | | $5.05 | $7.17 | $7.39 |