- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.21 / $62.40 / $245.76
| Facility | | $19.21 | $62.40 | $245.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.21 / $22.47 / $22.91
| Professional | | $19.21 | $22.47 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.71 / $73.03 / $115.74
| Facility | | $26.71 | $73.03 | $115.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $10.61 / $18.54
| Professional | | $10.61 | $10.61 | $18.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $24.15 / $65.06
| Facility | | $14.79 | $24.15 | $65.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.44 / $23.11 / $36.14
| Professional | | $15.44 | $23.11 | $36.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.21 / $30.32 / $49.78
| Facility | | $19.21 | $30.32 | $49.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $32.85 / $93.25
| Professional | | $16.93 | $32.85 | $93.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.78 / $31.78 / $31.78
| Facility | | $31.78 | $31.78 | $31.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $14.56 / $22.18
| Professional | | $10.61 | $14.56 | $22.18 |