- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.07 / $123.04 / $327.60
| Facility | | $35.07 | $123.04 | $327.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.69 / $25.68 / $52.52
| Professional | | $15.69 | $25.68 | $52.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.80 / $20.56 / $72.52
| Professional | | $14.80 | $20.56 | $72.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.28 / $32.89 / $40.40
| Professional | | $16.28 | $32.89 | $40.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.23 / $60.67 / $115.13
| Facility | | $19.23 | $60.67 | $115.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $22.76 / $43.81
| Professional | | $13.42 | $22.76 | $43.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.50 / $141.54 / $141.54
| Facility | | $51.50 | $141.54 | $141.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.64 / $44.68 / $66.66
| Professional | | $26.64 | $44.68 | $66.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.76 / $29.60 / $29.60
| Facility | | $17.76 | $29.60 | $29.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $20.35 / $41.36
| Professional | | $12.43 | $20.35 | $41.36 |