- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.75 / $117.85 / $273.97
| Facility | | $18.75 | $117.85 | $273.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.75 / $15.27 / $52.74
| Professional | | $12.75 | $15.27 | $52.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Professional | | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.03 / $25.92 / $60.52
| Facility | | $22.03 | $25.92 | $60.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.02 / $8.69 / $10.28
| Professional | | $8.02 | $8.69 | $10.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.54 / $67.91 / $110.71
| Facility | | $30.54 | $67.91 | $110.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $12.43 / $22.70
| Professional | | $10.01 | $12.43 | $22.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.17 / $23.80 / $54.19
| Professional | | $18.17 | $23.80 | $54.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $8.02 / $11.23
| Professional | | $5.62 | $8.02 | $11.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.21 / $16.48 / $23.13
| Professional | | $12.21 | $16.48 | $23.13 |