- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $53.70 / $407.38
| Facility | | $32.36 | $53.70 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $25.70 / $52.48
| Professional | | $17.38 | $25.70 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $16.22
| Professional | | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $97.72
| Facility | | $32.36 | $32.36 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $16.22 / $32.36
| Professional | | $15.49 | $16.22 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.88 / $21.88 / $40.74
| Facility | | $21.88 | $21.88 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $32.36 / $72.44
| Facility | | $23.44 | $32.36 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $69.18 / $79.43
| Professional | | $23.44 | $69.18 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $32.36 / $32.36
| Facility | | $14.79 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $19.50 / $33.88
| Professional | | $13.80 | $19.50 | $33.88 |