- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $47.86
| Facility | | $10.72 | $10.72 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $10.00 / $47.86
| Professional | | $7.94 | $10.00 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $100.00 / $107.15
| Facility | | $12.30 | $100.00 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $6.46 / $13.80
| Professional | | $4.27 | $6.46 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $15.14 / $24.55
| Facility | | $12.59 | $15.14 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $12.30 / $15.49
| Professional | | $6.61 | $12.30 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $10.72 / $12.88
| Professional | | $8.71 | $10.72 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $17.38
| Facility | | $10.72 | $10.72 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $10.72 / $47.86
| Professional | | $7.94 | $10.72 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $10.72 / $21.88
| Professional | | $6.46 | $10.72 | $21.88 |