- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $32.36 / $64.57
| Facility | | $18.20 | $32.36 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $12.59 / $16.98
| Professional | | $11.22 | $12.59 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.12 / $22.39 / $38.90
| Facility | | $9.12 | $22.39 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $24.55 / $25.12
| Professional | | $19.95 | $24.55 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $12.59 / $30.20
| Facility | | $12.59 | $12.59 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $10.47 / $26.92
| Professional | | $7.24 | $10.47 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $17.38 / $20.89
| Facility | | $7.24 | $17.38 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $10.47 / $22.39
| Professional | | $7.24 | $10.47 | $22.39 |