- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.12 / $106.80 / $253.97
| Facility | | $21.12 | $106.80 | $253.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.12 / $22.58 / $25.45
| Professional | | $21.12 | $22.58 | $25.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.23 / $34.79 / $202.12
| Facility | | $25.23 | $34.79 | $202.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $10.43 / $22.38
| Professional | | $10.43 | $10.43 | $22.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.83 / $26.86 / $44.27
| Facility | | $22.83 | $26.86 | $44.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.33 / $27.43 / $37.69
| Professional | | $26.33 | $27.43 | $37.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.07 / $26.07 / $31.57
| Professional | | $26.07 | $26.07 | $31.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.34 / $110.64 / $287.93
| Facility | | $25.34 | $110.64 | $287.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.12 / $23.14 / $26.07
| Professional | | $21.12 | $23.14 | $26.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.64 / $15.82 / $38.22
| Professional | | $15.64 | $15.82 | $38.22 |