- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $20.42 / $38.90
| Facility | | $15.49 | $20.42 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $11.22 / $25.12
| Professional | | $10.96 | $11.22 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.12 / $29.51 / $43.65
| Facility | | $9.12 | $29.51 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $21.38 / $51.29
| Professional | | $10.72 | $21.38 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Facility | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $13.80 / $75.86
| Facility | | $10.47 | $13.80 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $10.96 / $17.38
| Facility | | $10.47 | $10.96 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $11.22 / $11.22
| Professional | | $10.47 | $11.22 | $11.22 |