- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.13 / $28.48 / $149.47
| Facility | | $12.13 | $28.48 | $149.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.55 / $11.22 / $12.23
| Professional | | $10.55 | $11.22 | $12.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $12.87 / $12.87
| Professional | | $12.87 | $12.87 | $12.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.17 / $11.58 / $38.61
| Facility | | $10.17 | $11.58 | $38.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $5.09 / $7.85
| Professional | | $4.63 | $5.09 | $7.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $14.16 / $18.02
| Facility | | $12.87 | $14.16 | $18.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $13.51 / $17.37
| Professional | | $8.36 | $13.51 | $17.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.42 / $12.87 / $33.54
| Facility | | $9.42 | $12.87 | $33.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.48 / $14.87 / $28.78
| Professional | | $8.48 | $14.87 | $28.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.56 / $12.87 / $18.80
| Professional | | $6.56 | $12.87 | $18.80 |