- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.67 / $47.14 / $111.57
| Facility | | $13.67 | $47.14 | $111.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.67 / $13.67 / $13.67
| Professional | | $13.67 | $13.67 | $13.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.58 / $57.69 / $131.86
| Professional | | $14.58 | $57.69 | $131.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.63 / $30.81 / $66.66
| Facility | | $29.63 | $30.81 | $66.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.94 / $20.65 / $25.81
| Professional | | $9.94 | $20.65 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.06 / $37.06 / $37.06
| Professional | | $37.06 | $37.06 | $37.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $8.35 / $16.59
| Professional | | $7.66 | $8.35 | $16.59 |