- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.68 / $33.67 / $81.34
| Facility | | $19.68 | $33.67 | $81.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.52 / $24.89 / $26.55
| Professional | | $19.52 | $24.89 | $26.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.57 / $17.57 / $17.57
| Professional | | $17.57 | $17.57 | $17.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.64 / $23.79 / $86.29
| Facility | | $17.64 | $23.79 | $86.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.82 / $32.18 / $44.40
| Professional | | $14.82 | $32.18 | $44.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.57 / $17.57 / $34.69
| Professional | | $17.57 | $17.57 | $34.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.57 / $17.57 / $19.32
| Professional | | $17.57 | $17.57 | $19.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.28 / $29.28 / $43.92
| Facility | | $29.28 | $29.28 | $43.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $13.66 / $32.53
| Professional | | $10.25 | $13.66 | $32.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.17 / $17.57 / $17.57
| Professional | | $15.17 | $17.57 | $17.57 |