- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.98 / $168.78 / $387.40
| Facility | | $23.98 | $168.78 | $387.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.04 / $18.98 / $20.86
| Professional | | $13.04 | $18.98 | $20.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.10 / $80.68 / $80.68
| Facility | | $55.10 | $80.68 | $80.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.73 / $11.73 / $15.64
| Professional | | $11.73 | $11.73 | $15.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.40 / $21.54 / $68.50
| Facility | | $13.40 | $21.54 | $68.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $14.22 / $37.69
| Professional | | $12.31 | $14.22 | $37.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.97 / $19.55 / $37.86
| Facility | | $14.97 | $19.55 | $37.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.36 / $27.71 / $36.00
| Professional | | $26.36 | $27.71 | $36.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.73 / $13.70 / $26.40
| Professional | | $11.73 | $13.70 | $26.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.02 / $127.37 / $127.37
| Facility | | $69.02 | $127.37 | $127.37 |