- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $58.88 / $234.42
| Facility | | $14.13 | $58.88 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $13.49 / $43.65
| Professional | | $12.02 | $13.49 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $18.62 / $18.62
| Professional | | $14.13 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $41.69 / $58.88
| Facility | | $12.02 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $10.72 / $27.54
| Professional | | $8.32 | $10.72 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.76 / $12.88 / $18.62
| Facility | | $6.76 | $12.88 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $11.22 / $18.62
| Professional | | $7.76 | $11.22 | $18.62 |