- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.42 / $57.40 / $113.56
| Facility | | $13.42 | $57.40 | $113.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $13.76 / $15.36
| Professional | | $13.42 | $13.76 | $15.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.76 / $66.47 / $131.34
| Facility | | $25.76 | $66.47 | $131.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.20 / $32.00 / $43.00
| Professional | | $17.20 | $32.00 | $43.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.26 / $49.86 / $104.70
| Facility | | $31.26 | $49.86 | $104.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $10.82 / $24.78
| Professional | | $8.71 | $10.82 | $24.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.42 / $19.87 / $33.65
| Facility | | $13.42 | $19.87 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $24.64 / $32.00
| Professional | | $19.00 | $24.64 | $32.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.46 / $9.46 / $13.62
| Professional | | $9.46 | $9.46 | $13.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.22 / $10.32 / $20.64
| Professional | | $7.22 | $10.32 | $20.64 |