- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.28 / $59.36 / $198.48
| Facility | | $13.28 | $59.36 | $198.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $10.76 / $17.47
| Professional | | $10.76 | $10.76 | $17.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.85 / $17.73 / $134.31
| Facility | | $12.85 | $17.73 | $134.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $5.31 / $15.35
| Professional | | $5.31 | $5.31 | $15.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $18.64 / $28.32
| Facility | | $15.85 | $18.64 | $28.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $18.07 / $19.23
| Professional | | $13.42 | $18.07 | $19.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.28 / $13.28 / $16.07
| Professional | | $13.28 | $13.28 | $16.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.28 / $33.20 / $198.48
| Facility | | $13.28 | $33.20 | $198.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $13.28 / $17.47
| Professional | | $10.76 | $13.28 | $17.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.97 / $10.85 / $26.23
| Professional | | $7.97 | $10.85 | $26.23 |