- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.12 / $47.73 / $107.04
| Facility | | $13.12 | $47.73 | $107.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.12 / $13.12 / $13.12
| Professional | | $13.12 | $13.12 | $13.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.24 / $41.85 / $95.69
| Professional | | $12.24 | $41.85 | $95.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.43 / $29.56 / $63.09
| Facility | | $28.43 | $29.56 | $63.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.56 / $20.23 / $25.30
| Professional | | $9.56 | $20.23 | $25.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.54 / $35.54 / $35.54
| Professional | | $35.54 | $35.54 | $35.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $7.35 / $15.92
| Professional | | $2.94 | $7.35 | $15.92 |