- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.68 / $158.83 / $177.03
| Facility | | $150.68 | $158.83 | $177.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $25.33 / $25.33
| Professional | | $22.07 | $25.33 | $25.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.88 / $134.76 / $257.98
| Facility | | $93.88 | $134.76 | $257.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.71 / $20.71 / $20.71
| Professional | | $20.71 | $20.71 | $20.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.07 / $28.07 / $117.40
| Facility | | $28.07 | $28.07 | $117.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.66 / $19.41 / $26.50
| Professional | | $11.66 | $19.41 | $26.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.07 / $28.07 / $117.40
| Facility | | $28.07 | $28.07 | $117.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.66 / $19.41 / $26.50
| Professional | | $11.66 | $19.41 | $26.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $12.17 / $28.39
| Professional | | $10.06 | $12.17 | $28.39 |