- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.50 / $20.05 / $66.54
| Facility | | $18.50 | $20.05 | $66.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $18.50 / $19.32
| Professional | | $12.25 | $18.50 | $19.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.19 / $76.78 / $86.72
| Facility | | $39.19 | $76.78 | $86.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.88 / $13.88 / $16.19
| Professional | | $13.88 | $13.88 | $16.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.48 / $23.67 / $60.49
| Facility | | $15.48 | $23.67 | $60.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.69 / $24.08 / $46.62
| Professional | | $19.69 | $24.08 | $46.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.50 / $25.03 / $43.74
| Facility | | $18.50 | $25.03 | $43.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.47 / $32.03 / $41.00
| Professional | | $30.47 | $32.03 | $41.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.76 / $27.76 / $27.76
| Facility | | $27.76 | $27.76 | $27.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.41 / $15.26 / $30.51
| Professional | | $10.41 | $15.26 | $30.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.31 / $182.22 / $182.22
| Facility | | $77.31 | $182.22 | $182.22 |