- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $19.50 / $63.10
| Facility | | $16.22 | $19.50 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.72 / $46.77
| Professional | | $10.00 | $10.72 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.33 / $29.51 / $43.65
| Facility | | $9.33 | $29.51 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $20.42 / $48.98
| Professional | | $10.23 | $20.42 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.75 / $16.60 / $75.86
| Facility | | $11.75 | $16.60 | $75.86 |
- 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
- $10.72 / $17.38 / $17.38
| Facility | | $10.72 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Professional | | $10.72 | $10.72 | $10.72 |