- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.48 / $20.96 / $270.74
| Facility | | $10.48 | $20.96 | $270.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Professional | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $9.86 / $9.86
| Professional | | $9.86 | $9.86 | $9.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Facility | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Professional | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.48 / $3.24 / $3.37
| Professional | | $0.48 | $3.24 | $3.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.06 / $10.76 / $15.96
| Facility | | $2.06 | $10.76 | $15.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.76 / $10.27 / $13.15
| Facility | | $9.76 | $10.27 | $13.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.76 / $10.27 / $13.15
| Professional | | $9.76 | $10.27 | $13.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.96 / $10.27 / $10.27
| Professional | | $9.96 | $10.27 | $10.27 |