- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.35 / $28.55 / $65.29
| Facility | | $15.35 | $28.55 | $65.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $15.60 / $30.46
| Professional | | $13.06 | $15.60 | $30.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.12 / $34.04 / $35.86
| Facility | | $29.12 | $34.04 | $35.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $11.39 / $15.53
| Professional | | $11.39 | $11.39 | $15.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.06 / $13.06 / $13.06
| Facility | | $13.06 | $13.06 | $13.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $13.06 / $33.59
| Professional | | $13.06 | $13.06 | $33.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.54 / $15.60 / $36.95
| Facility | | $15.54 | $15.60 | $36.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.79 / $22.79 / $22.79
| Professional | | $22.79 | $22.79 | $22.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.57 / $14.57 / $19.70
| Facility | | $14.57 | $14.57 | $19.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $13.06 / $17.23
| Professional | | $13.06 | $13.06 | $17.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |