- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.64 / $87.20 / $187.88
| Facility | | $22.64 | $87.20 | $187.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $13.26 / $26.75
| Professional | | $10.84 | $13.26 | $26.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.24 / $12.21 / $44.94
| Facility | | $11.24 | $12.21 | $44.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.15 / $13.22 / $16.52
| Professional | | $7.15 | $13.22 | $16.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.84 / $21.70 / $32.15
| Facility | | $10.84 | $21.70 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $11.53 / $13.84
| Professional | | $11.53 | $11.53 | $13.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $11.53 / $11.53
| Professional | | $11.53 | $11.53 | $11.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.30 / $25.94 / $42.43
| Facility | | $17.30 | $25.94 | $42.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.80 / $19.79 / $20.49
| Professional | | $9.80 | $19.79 | $20.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $6.86 / $18.98
| Professional | | $4.84 | $6.86 | $18.98 |