- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.25 / $58.75 / $240.72
| Facility | | $13.25 | $58.75 | $240.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $10.73 / $13.25
| Professional | | $10.73 | $10.73 | $13.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.82 / $17.69 / $125.31
| Facility | | $12.82 | $17.69 | $125.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $5.30 / $15.33
| Professional | | $5.30 | $5.30 | $15.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.64 / $19.21 / $28.25
| Facility | | $18.64 | $19.21 | $28.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $17.48 / $19.10
| Professional | | $13.42 | $17.48 | $19.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.25 / $13.25 / $16.05
| Professional | | $13.25 | $13.25 | $16.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.25 / $26.50 / $197.04
| Facility | | $13.25 | $26.50 | $197.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $13.25 / $15.46
| Professional | | $10.73 | $13.25 | $15.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.95 / $10.84 / $26.19
| Professional | | $7.95 | $10.84 | $26.19 |