- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $102.33 / $354.81
| Facility | | $18.20 | $102.33 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $12.88 / $19.95
| Professional | | $10.96 | $12.88 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $14.45 / $75.86
| Facility | | $9.55 | $14.45 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $14.79 / $32.36
| Professional | | $8.71 | $14.79 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $18.62
| Professional | | $11.22 | $11.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $12.30
| Professional | | $11.22 | $11.22 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $11.22 / $18.62
| Facility | | $7.08 | $11.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $7.76 / $18.62
| Professional | | $6.46 | $7.76 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $18.62
| Professional | | $11.22 | $11.22 | $18.62 |