- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.50 / $41.71 / $55.38
| Facility | | $23.50 | $41.71 | $55.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.82 / $19.57 / $28.87
| Professional | | $18.82 | $19.57 | $28.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.17 / $25.10 / $31.38
| Facility | | $11.17 | $25.10 | $31.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.84 / $52.84 / $52.84
| Professional | | $52.84 | $52.84 | $52.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.32 / $29.38 / $90.90
| Facility | | $16.32 | $29.38 | $90.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.28 / $6.28 / $25.10
| Professional | | $6.28 | $6.28 | $25.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.28 / $6.28 / $6.28
| Professional | | $6.28 | $6.28 | $6.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.65 / $37.65 / $37.65
| Facility | | $37.65 | $37.65 | $37.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $11.70 / $25.10
| Professional | | $10.54 | $11.70 | $25.10 |