- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.23 / $34.47 / $68.94
| Facility | | $17.23 | $34.47 | $68.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.23 / $27.58 / $147.76
| Professional | | $17.23 | $27.58 | $147.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.37 / $145.57 / $247.19
| Facility | | $41.37 | $145.57 | $247.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.89 / $18.80 / $21.60
| Professional | | $12.89 | $18.80 | $21.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.94 / $14.94 / $14.94
| Facility | | $14.94 | $14.94 | $14.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.60 / $26.43 / $33.04
| Professional | | $10.60 | $26.43 | $33.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.64 / $12.64 / $12.64
| Professional | | $12.64 | $12.64 | $12.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.02 / $23.57 / $33.00
| Facility | | $15.02 | $23.57 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.92 / $22.98 / $31.57
| Professional | | $17.92 | $22.98 | $31.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.65 / $10.02 / $13.79
| Professional | | $9.65 | $10.02 | $13.79 |