- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.88 / $61.60 / $61.60
| Facility | | $38.88 | $61.60 | $61.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.73 / $32.68 / $32.68
| Professional | | $11.73 | $32.68 | $32.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.34 / $17.75 / $65.34
| Facility | | $16.34 | $17.75 | $65.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.27 / $19.41 / $24.26
| Professional | | $9.27 | $19.41 | $24.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.75 / $26.33 / $34.31
| Facility | | $15.75 | $26.33 | $34.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.76 / $16.76 / $20.11
| Professional | | $16.76 | $16.76 | $20.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.76 / $16.76 / $16.76
| Professional | | $16.76 | $16.76 | $16.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.14 / $37.71 / $61.68
| Facility | | $25.14 | $37.71 | $61.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.25 / $28.52 / $29.28
| Professional | | $14.25 | $28.52 | $29.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $13.41 / $24.82
| Professional | | $10.06 | $13.41 | $24.82 |