- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.20 / $29.66 / $143.75
| Facility | | $16.20 | $29.66 | $143.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.31 / $20.50 / $20.50
| Professional | | $10.31 | $20.50 | $20.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.46 / $26.65 / $30.75
| Facility | | $13.46 | $26.65 | $30.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $11.56 / $18.82
| Professional | | $9.83 | $11.56 | $18.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.61 / $41.51 / $66.36
| Facility | | $23.61 | $41.51 | $66.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $10.94 / $32.34
| Professional | | $7.60 | $10.94 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $13.83 / $27.42
| Professional | | $8.75 | $13.83 | $27.42 |