- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.73 / $46.75 / $56.02
| Facility | | $21.73 | $46.75 | $56.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.67 / $14.67 / $20.14
| Professional | | $10.67 | $14.67 | $20.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.84 / $12.84 / $12.84
| Professional | | $12.84 | $12.84 | $12.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.56 / $33.54 / $50.33
| Facility | | $31.56 | $33.54 | $50.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.72 / $29.37 / $29.37
| Professional | | $23.72 | $29.37 | $29.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.54 / $21.22 / $103.59
| Facility | | $12.54 | $21.22 | $103.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $28.91 / $37.00
| Professional | | $10.65 | $28.91 | $37.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.68 / $14.68 / $35.06
| Facility | | $14.68 | $14.68 | $35.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.46 / $13.33 / $37.68
| Professional | | $8.46 | $13.33 | $37.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.41 / $55.41 / $55.41
| Facility | | $55.41 | $55.41 | $55.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.46 / $12.09 / $32.24
| Professional | | $8.46 | $12.09 | $32.24 |