- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.07 / $116.45 / $173.10
| Facility | | $15.07 | $116.45 | $173.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $16.48 / $22.16
| Professional | | $14.22 | $16.48 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.48 / $9.48 / $46.46
| Professional | | $9.48 | $9.48 | $46.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $21.07 / $25.88
| Professional | | $10.43 | $21.07 | $25.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.46 / $40.89 / $73.37
| Facility | | $12.46 | $40.89 | $73.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.65 / $14.58 / $28.02
| Professional | | $8.65 | $14.58 | $28.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.63 / $95.40 / $95.40
| Facility | | $33.63 | $95.40 | $95.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.96 / $13.01 / $23.86
| Professional | | $7.96 | $13.01 | $23.86 |