- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.27 / $44.08 / $80.09
| Facility | | $14.27 | $44.08 | $80.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.28 / $14.28 / $17.63
| Professional | | $14.28 | $14.28 | $17.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.05 / $23.54 / $178.37
| Facility | | $17.05 | $23.54 | $178.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.05 / $7.05 / $20.39
| Professional | | $7.05 | $7.05 | $20.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.93 / $24.62 / $37.61
| Facility | | $20.93 | $24.62 | $37.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $24.00 / $25.81
| Professional | | $18.00 | $24.00 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.63 / $17.63 / $21.35
| Professional | | $17.63 | $17.63 | $21.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.63 / $28.56 / $151.79
| Facility | | $17.63 | $28.56 | $151.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.28 / $17.63 / $20.56
| Professional | | $14.28 | $17.63 | $20.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.58 / $14.41 / $34.83
| Professional | | $10.58 | $14.41 | $34.83 |