- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.28 / $42.28 / $113.01
| Facility | | $42.28 | $42.28 | $113.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.28 / $42.28 / $42.28
| Professional | | $42.28 | $42.28 | $42.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.74 / $42.22 / $101.47
| Facility | | $13.74 | $42.22 | $101.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $21.90 / $31.03
| Professional | | $7.24 | $21.90 | $31.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.04 / $29.33 / $49.46
| Facility | | $29.04 | $29.33 | $49.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.57 / $48.57 / $60.71
| Professional | | $48.57 | $48.57 | $60.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.28 / $42.28 / $44.39
| Professional | | $42.28 | $42.28 | $44.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.72 / $18.72 / $42.22
| Professional | | $16.72 | $18.72 | $42.22 |