- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $15.14 / $45.71
| Facility | | $10.96 | $15.14 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $10.00 / $12.02
| Professional | | $8.91 | $10.00 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $11.75 / $23.44
| Facility | | $5.62 | $11.75 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $13.18 / $16.98
| Professional | | $10.72 | $13.18 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $10.72 / $10.72
| Facility | | $10.23 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Professional | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $13.49 / $29.51
| Facility | | $11.22 | $13.49 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $10.72 / $22.91
| Facility | | $10.47 | $10.72 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.72 / $11.75
| Professional | | $10.47 | $10.72 | $11.75 |