- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.06 / $57.04 / $136.34
| Facility | | $13.06 | $57.04 | $136.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.89 / $10.89 / $15.67
| Professional | | $10.89 | $10.89 | $15.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.01 / $17.94 / $135.84
| Facility | | $13.01 | $17.94 | $135.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.38 / $5.38 / $15.54
| Professional | | $5.38 | $5.38 | $15.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $18.64 / $28.68
| Facility | | $15.85 | $18.64 | $28.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.75 / $18.29 / $19.62
| Professional | | $13.75 | $18.29 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.65 / $207.65 / $207.65
| Facility | | $207.65 | $207.65 | $207.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.44 / $13.44 / $16.28
| Professional | | $13.44 | $13.44 | $16.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.06 / $57.04 / $124.64
| Facility | | $13.06 | $57.04 | $124.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.89 / $13.44 / $15.67
| Professional | | $10.89 | $13.44 | $15.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.06 / $10.98 / $32.03
| Professional | | $8.06 | $10.98 | $32.03 |