- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.76 / $81.84 / $103.90
| Facility | | $12.76 | $81.84 | $103.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.34 / $14.77 / $19.14
| Professional | | $10.34 | $14.77 | $19.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.35 / $17.03 / $129.12
| Facility | | $12.35 | $17.03 | $129.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $5.09 / $14.77
| Professional | | $5.09 | $5.09 | $14.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.22 / $17.89 / $27.20
| Facility | | $15.22 | $17.89 | $27.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.77 / $15.96 / $18.53
| Professional | | $12.77 | $15.96 | $18.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $55.00
| Facility | | $55.00 | $55.00 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.76 / $12.76 / $15.45
| Professional | | $12.76 | $12.76 | $15.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.76 / $57.97 / $131.47
| Facility | | $12.76 | $57.97 | $131.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.34 / $14.03 / $17.52
| Professional | | $10.34 | $14.03 | $17.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $10.43 / $25.22
| Professional | | $7.66 | $10.43 | $25.22 |