- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $102.33 / $147.91
| Facility | | $45.71 | $102.33 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $16.60 / $32.36
| Professional | | $12.88 | $16.60 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $16.22 / $51.29
| Facility | | $15.85 | $16.22 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $22.39 / $35.48
| Professional | | $11.75 | $22.39 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $67.61 / $97.72
| Facility | | $18.62 | $67.61 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $15.85 / $16.60
| Professional | | $12.59 | $15.85 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $18.62 / $33.11
| Professional | | $16.22 | $18.62 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.33 / $9.33 / $89.13
| Facility | | $9.33 | $9.33 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $10.96 / $25.70
| Professional | | $7.76 | $10.96 | $25.70 |