- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.60 / $33.08 / $108.01
| Facility | | $20.60 | $33.08 | $108.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.61 / $20.61 / $25.45
| Professional | | $20.61 | $20.61 | $25.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.63 / $37.40 / $176.29
| Facility | | $24.63 | $37.40 | $176.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.18 / $10.18 / $21.63
| Professional | | $10.18 | $10.18 | $21.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.86 / $29.32 / $36.65
| Professional | | $25.86 | $29.32 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.45 / $25.45 / $30.82
| Professional | | $25.45 | $25.45 | $30.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.60 / $25.45 / $113.76
| Facility | | $20.60 | $25.45 | $113.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.61 / $20.61 / $25.45
| Professional | | $20.61 | $20.61 | $25.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.27 / $15.27 / $36.90
| Professional | | $15.27 | $15.27 | $36.90 |