- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.75 / $74.88 / $223.64
| Facility | | $28.75 | $74.88 | $223.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.65 / $16.30 / $24.16
| Professional | | $11.65 | $16.30 | $24.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.08 / $13.12 / $48.30
| Facility | | $12.08 | $13.12 | $48.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $14.04 / $17.55
| Professional | | $7.60 | $14.04 | $17.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.65 / $21.64 / $25.37
| Facility | | $11.65 | $21.64 | $25.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.39 / $12.39 / $14.87
| Professional | | $12.39 | $12.39 | $14.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.39 / $12.39 / $12.39
| Professional | | $12.39 | $12.39 | $12.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.59 / $27.88 / $45.60
| Facility | | $18.59 | $27.88 | $45.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $21.53 / $21.66
| Professional | | $10.53 | $21.53 | $21.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.20 / $7.37 / $25.35
| Professional | | $5.20 | $7.37 | $25.35 |