- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.07 / $21.07 / $52.68
| Facility | | $21.07 | $21.07 | $52.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $17.07 / $21.07
| Professional | | $17.07 | $17.07 | $21.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.39 / $28.13 / $213.01
| Facility | | $20.39 | $28.13 | $213.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.43 / $8.43 / $24.36
| Professional | | $8.43 | $8.43 | $24.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.05 / $29.47 / $44.96
| Facility | | $25.05 | $29.47 | $44.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.28 / $28.67 / $30.46
| Professional | | $21.28 | $28.67 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.07 / $21.07 / $25.52
| Professional | | $21.07 | $21.07 | $25.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.07 / $21.07 / $52.68
| Facility | | $21.07 | $21.07 | $52.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $17.07 / $21.07
| Professional | | $17.07 | $17.07 | $21.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.64 / $17.22 / $43.05
| Professional | | $12.64 | $17.22 | $43.05 |