- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.42 / $26.87 / $27.02
| Professional | | $18.42 | $26.87 | $27.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.66 / $178.66 / $178.66
| Facility | | $178.66 | $178.66 | $178.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $188.20
| Facility | | $1.57 | $1.57 | $188.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $29.77 / $76.22
| Professional | | $10.46 | $29.77 | $76.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $188.20
| Facility | | $1.57 | $1.57 | $188.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $29.77 / $76.22
| Professional | | $10.46 | $29.77 | $76.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.13 / $20.52 / $73.38
| Professional | | $13.13 | $20.52 | $73.38 |