- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $52.63
| Facility | | $21.05 | $21.05 | $52.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $17.05 / $21.05
| Professional | | $17.05 | $17.05 | $21.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.37 / $28.10 / $191.53
| Facility | | $20.37 | $28.10 | $191.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.42 / $8.42 / $21.90
| Professional | | $8.42 | $8.42 | $21.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.51 / $26.48 / $43.34
| Facility | | $22.51 | $26.48 | $43.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.28 / $25.77 / $30.46
| Professional | | $21.28 | $25.77 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $25.49
| Professional | | $21.05 | $21.05 | $25.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $52.63
| Facility | | $21.05 | $21.05 | $52.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $17.05 / $21.05
| Professional | | $17.05 | $17.05 | $21.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.63 / $15.47 / $37.40
| Professional | | $12.63 | $15.47 | $37.40 |