- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.13 / $24.68 / $322.56
| Facility | | $20.13 | $24.68 | $322.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.22 / $14.10 / $20.13
| Professional | | $10.22 | $14.10 | $20.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.43 / $10.43 / $20.13
| Facility | | $10.43 | $10.43 | $20.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $10.43 / $14.81
| Professional | | $10.43 | $10.43 | $14.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.50 / $30.55 / $35.25
| Facility | | $23.50 | $30.55 | $35.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.68 / $28.20 / $35.25
| Professional | | $24.68 | $28.20 | $35.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $12.00 / $24.11
| Professional | | $12.00 | $12.00 | $24.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.64 / $11.72 / $16.82
| Professional | | $6.64 | $11.72 | $16.82 |