- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.87 / $23.12 / $175.47
| Facility | | $11.87 | $23.12 | $175.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.90 / $12.17 / $18.77
| Professional | | $10.90 | $12.17 | $18.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.37 / $16.35 / $19.64
| Facility | | $11.37 | $16.35 | $19.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $12.05 / $13.08
| Professional | | $12.05 | $12.05 | $13.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.52 / $23.43 / $30.63
| Professional | | $10.52 | $23.43 | $30.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.06 / $17.25 / $32.96
| Facility | | $12.06 | $17.25 | $32.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $12.78 / $15.08
| Professional | | $12.06 | $12.78 | $15.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.79 / $13.49 / $32.36
| Facility | | $10.79 | $13.49 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.37 / $16.35 / $30.96
| Facility | | $11.37 | $16.35 | $30.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $13.08 / $14.44
| Professional | | $12.05 | $13.08 | $14.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $12.06 / $12.06
| Professional | | $12.06 | $12.06 | $12.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $12.06 / $14.47
| Professional | | $12.06 | $12.06 | $14.47 |