- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.83 / $27.50 / $207.40
| Facility | | $13.83 | $27.50 | $207.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.93 / $14.17 / $15.93
| Professional | | $8.93 | $14.17 | $15.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.33 / $15.40 / $50.61
| Facility | | $13.33 | $15.40 | $50.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $7.98 / $11.60
| Professional | | $2.11 | $7.98 | $11.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.87 / $20.23 / $22.77
| Facility | | $16.87 | $20.23 | $22.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.87 / $19.39 / $23.91
| Professional | | $16.87 | $19.39 | $23.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.34 / $16.87 / $43.61
| Facility | | $12.34 | $16.87 | $43.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.11 / $19.41 / $80.34
| Professional | | $11.11 | $19.41 | $80.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.87 / $16.87 / $160.50
| Facility | | $16.87 | $16.87 | $160.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.09 / $10.11 / $16.87
| Professional | | $7.09 | $10.11 | $16.87 |