- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $20.89 / $38.90
| Facility | | $16.22 | $20.89 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $11.22 / $30.20
| Professional | | $10.96 | $11.22 | $30.20 |
- 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 / $52.48
| Professional | | $10.72 | $21.38 | $52.48 |
- 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
- $7.76 / $14.45 / $75.86
| Facility | | $7.76 | $14.45 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $10.96
| Professional | | $10.96 | $10.96 | $10.96 |
- 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 |