- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $79.43 / $147.91
| Facility | | $17.78 | $79.43 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.85 / $79.43
| Professional | | $12.88 | $15.85 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $165.96 / $177.83
| Facility | | $20.42 | $165.96 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $10.47 / $22.91
| Professional | | $7.08 | $10.47 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.89 / $25.12 / $40.74
| Facility | | $20.89 | $25.12 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $20.42 / $25.70
| Professional | | $10.96 | $20.42 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $17.78 / $21.38
| Professional | | $14.45 | $17.78 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $147.91
| Facility | | $17.78 | $17.78 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $17.78 / $64.57
| Professional | | $14.13 | $17.78 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $17.78 / $36.31
| Professional | | $10.47 | $17.78 | $36.31 |