- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.07 / $22.67 / $28.85
| Facility | | $12.07 | $22.67 | $28.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.79 / $13.06 / $13.78
| Professional | | $12.79 | $13.06 | $13.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.72 / $23.51 / $41.79
| Facility | | $16.72 | $23.51 | $41.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $13.06 / $13.06
| Professional | | $13.06 | $13.06 | $13.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $19.77
| Facility | | $12.32 | $12.32 | $19.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $13.06 / $13.06
| Professional | | $13.06 | $13.06 | $13.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.46 / $19.79 / $31.25
| Facility | | $12.46 | $19.79 | $31.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.80 / $14.37 / $21.42
| Professional | | $9.80 | $14.37 | $21.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.70 / $19.70 / $19.70
| Facility | | $19.70 | $19.70 | $19.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $13.06 / $13.06
| Professional | | $13.06 | $13.06 | $13.06 |