- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.65 / $63.04 / $169.84
| Facility | | $27.65 | $63.04 | $169.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.34 / $23.24 / $23.24
| Professional | | $8.34 | $23.24 | $23.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.63 / $12.63 / $46.50
| Facility | | $11.63 | $12.63 | $46.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.30 / $13.63 / $17.04
| Professional | | $7.30 | $13.63 | $17.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.20 / $20.83 / $24.40
| Facility | | $11.20 | $20.83 | $24.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.92 / $11.92 / $14.30
| Professional | | $11.92 | $11.92 | $14.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.92 / $11.92 / $11.92
| Professional | | $11.92 | $11.92 | $11.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.88 / $26.82 / $43.87
| Facility | | $17.88 | $26.82 | $43.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $20.37 / $21.08
| Professional | | $10.13 | $20.37 | $21.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.09 / $19.62
| Professional | | $5.01 | $7.09 | $19.62 |