- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.54 / $140.87 / $213.85
| Facility | | $14.54 | $140.87 | $213.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.41 / $14.54 / $14.91
| Professional | | $12.41 | $14.54 | $14.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $17.00 / $25.49
| Professional | | $15.00 | $17.00 | $25.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.89 / $54.06 / $106.32
| Facility | | $33.89 | $54.06 | $106.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.44 / $21.48 / $26.85
| Professional | | $10.44 | $21.48 | $26.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.69 / $14.54 / $24.72
| Facility | | $9.69 | $14.54 | $24.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.91 / $14.91 / $18.82
| Professional | | $14.91 | $14.91 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $10.25 / $14.76
| Professional | | $10.25 | $10.25 | $14.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.78 / $16.78 / $22.37
| Facility | | $16.78 | $16.78 | $22.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $11.18 / $22.37
| Professional | | $7.83 | $11.18 | $22.37 |