- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $77.62 / $141.25
| Facility | | $35.48 | $77.62 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $4.57 / $6.03
| Professional | | $3.02 | $4.57 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.47 / $4.57 / $14.45
| Facility | | $4.47 | $4.57 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $5.75 / $10.23
| Professional | | $3.24 | $5.75 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.13 / $19.05 / $27.54
| Facility | | $5.13 | $19.05 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $4.37 / $4.68
| Professional | | $3.55 | $4.37 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $5.13 / $16.22
| Professional | | $3.63 | $5.13 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.57 / $5.13 / $9.12
| Professional | | $4.57 | $5.13 | $9.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $8.91
| Facility | | $2.57 | $2.57 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $3.09 / $6.31
| Professional | | $2.19 | $3.09 | $6.31 |