- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $61.66 / $85.11
| Facility | | $18.20 | $61.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $19.95 / $25.70
| Professional | | $16.98 | $19.95 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $16.22 / $40.74
| Professional | | $11.48 | $16.22 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $21.38 / $43.65
| Facility | | $17.78 | $21.38 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $33.11 / $41.69
| Professional | | $31.62 | $33.11 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $26.92 / $63.10
| Professional | | $26.92 | $26.92 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $16.22 / $40.74
| Professional | | $11.48 | $16.22 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $26.92 / $32.36
| Facility | | $16.22 | $26.92 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $16.22 / $61.66
| Professional | | $12.30 | $16.22 | $61.66 |