- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.11 / $20.66 / $35.71
| Professional | | $17.11 | $20.66 | $35.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.64 / $107.64 / $107.64
| Facility | | $107.64 | $107.64 | $107.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.30 / $44.52 / $138.58
| Professional | | $20.30 | $44.52 | $138.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.03 / $31.46 / $71.39
| Facility | | $25.03 | $31.46 | $71.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.04 / $43.31 / $69.23
| Professional | | $30.04 | $43.31 | $69.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.74 / $20.61 / $43.00
| Professional | | $11.74 | $20.61 | $43.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.86 / $37.83 / $56.57
| Professional | | $29.86 | $37.83 | $56.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.62 / $33.18 / $43.80
| Professional | | $26.62 | $33.18 | $43.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.64 / $107.64 / $107.64
| Facility | | $107.64 | $107.64 | $107.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.12 / $40.39 / $164.61
| Professional | | $20.12 | $40.39 | $164.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.36 / $30.05 / $67.17
| Professional | | $18.36 | $30.05 | $67.17 |