- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.69 / $94.21 / $104.62
| Facility | | $21.69 | $94.21 | $104.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.38 / $20.51 / $21.69
| Professional | | $13.38 | $20.51 | $21.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.92 / $56.55 / $60.68
| Facility | | $45.92 | $56.55 | $60.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.20 / $12.20 / $18.98
| Professional | | $12.20 | $12.20 | $18.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.42 / $27.68 / $71.17
| Facility | | $14.42 | $27.68 | $71.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.63 / $14.22 / $39.24
| Professional | | $12.63 | $14.22 | $39.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.58 / $16.27 / $27.11
| Facility | | $13.58 | $16.27 | $27.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.62 / $27.11 / $27.11
| Professional | | $17.62 | $27.11 | $27.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.20 / $13.56 / $27.11
| Professional | | $12.20 | $13.56 | $27.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.38 / $128.77 / $128.77
| Facility | | $43.38 | $128.77 | $128.77 |