- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.39 / $31.20 / $58.34
| Facility | | $19.39 | $31.20 | $58.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.30 / $31.20 / $31.20
| Professional | | $27.30 | $31.20 | $31.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.26 / $71.11 / $81.36
| Facility | | $59.26 | $71.11 | $81.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $17.80 / $25.35
| Professional | | $17.55 | $17.80 | $25.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.57 / $29.63 / $102.31
| Facility | | $13.57 | $29.63 | $102.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.68 / $15.07 / $56.27
| Professional | | $12.68 | $15.07 | $56.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $28.40 / $40.95
| Facility | | $19.50 | $28.40 | $40.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $26.95 / $36.00
| Professional | | $6.30 | $26.95 | $36.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $18.35 / $39.00
| Professional | | $13.36 | $18.35 | $39.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.40 / $185.25 / $185.25
| Facility | | $64.40 | $185.25 | $185.25 |