- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.09 / $34.36 / $113.75
| Facility | | $19.09 | $34.36 | $113.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.42 / $22.68 / $46.16
| Professional | | $10.42 | $22.68 | $46.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.27 / $15.27 / $15.27
| Professional | | $15.27 | $15.27 | $15.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.05 / $29.91 / $40.33
| Facility | | $22.05 | $29.91 | $40.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.18 / $24.18 / $24.18
| Professional | | $24.18 | $24.18 | $24.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.54 / $16.54 / $32.93
| Facility | | $13.54 | $16.54 | $32.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $29.32 / $36.65
| Professional | | $11.38 | $29.32 | $36.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.50 / $13.23 / $120.89
| Facility | | $10.50 | $13.23 | $120.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.69 / $10.69 / $26.72
| Professional | | $10.69 | $10.69 | $26.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.69 / $10.69 / $15.27
| Professional | | $10.69 | $10.69 | $15.27 |