- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.63 / $54.77 / $142.50
| Facility | | $19.63 | $54.77 | $142.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.15 / $17.53 / $18.27
| Professional | | $13.15 | $17.53 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $11.78 / $13.63
| Professional | | $11.78 | $11.78 | $13.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.34 / $21.08 / $50.47
| Facility | | $13.34 | $21.08 | $50.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $22.72 / $29.94
| Professional | | $13.01 | $22.72 | $29.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $13.74 / $27.48
| Professional | | $11.78 | $13.74 | $27.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $10.01 / $13.76
| Professional | | $2.50 | $10.01 | $13.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.63 / $19.63 / $29.44
| Facility | | $19.63 | $19.63 | $29.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $11.60 / $27.42
| Professional | | $6.87 | $11.60 | $27.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.17 / $12.51 / $12.51
| Professional | | $10.17 | $12.51 | $12.51 |