- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $57.54 / $151.36
| Facility | | $10.47 | $57.54 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $25.70 / $34.67
| Professional | | $22.91 | $25.70 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $20.42 / $20.42
| Professional | | $17.78 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $36.31 / $75.86
| Facility | | $20.42 | $36.31 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $32.36 / $56.23
| Professional | | $19.50 | $32.36 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $144.54 / $269.15
| Facility | | $30.90 | $144.54 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $40.74
| Professional | | $17.78 | $17.78 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $14.13 / $19.50
| Professional | | $3.55 | $14.13 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $23.99 / $36.31
| Facility | | $12.30 | $23.99 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $17.38 / $39.81
| Professional | | $12.30 | $17.38 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $29.51
| Professional | | $17.78 | $17.78 | $29.51 |