- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $51.05
| Facility | | $20.42 | $20.42 | $51.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $16.54 / $20.42
| Professional | | $16.54 | $16.54 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.76 / $27.26 / $213.28
| Facility | | $19.76 | $27.26 | $213.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $8.17 / $23.62
| Professional | | $8.17 | $8.17 | $23.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.10 / $28.35 / $43.55
| Facility | | $24.10 | $28.35 | $43.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.62 / $27.79 / $29.72
| Professional | | $20.62 | $27.79 | $29.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $24.73
| Professional | | $20.42 | $20.42 | $24.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $51.05
| Facility | | $20.42 | $20.42 | $51.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $16.54 / $20.42
| Professional | | $16.54 | $16.54 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $16.69 / $40.34
| Professional | | $12.25 | $16.69 | $40.34 |