- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $70.79 / $169.82
| Facility | | $12.02 | $70.79 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $22.39 / $28.18
| Professional | | $12.02 | $22.39 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.72 / $28.18
| Professional | | $10.23 | $10.72 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $61.66 / $128.82
| Facility | | $29.51 | $61.66 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $28.18 / $36.31
| Professional | | $16.22 | $28.18 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $38.90 / $125.89
| Facility | | $10.00 | $38.90 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $9.77 / $22.39
| Professional | | $7.08 | $9.77 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $17.78 / $44.67
| Facility | | $12.02 | $17.78 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.80 / $15.49 / $18.62
| Facility | | $13.80 | $15.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $10.72 / $21.88
| Professional | | $6.46 | $10.72 | $21.88 |