- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $30.20 / $43.65
| Facility | | $28.84 | $30.20 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $28.84 / $33.88
| Professional | | $18.20 | $28.84 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $109.65 / $131.83
| Facility | | $36.31 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $30.20 / $43.65
| Professional | | $14.13 | $30.20 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $53.70
| Professional | | $16.22 | $16.22 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $33.11 / $40.74
| Professional | | $30.20 | $33.11 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $36.31 / $36.31
| Facility | | $28.84 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $35.48 / $63.10
| Professional | | $14.13 | $35.48 | $63.10 |