- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.07 / $376.80 / $602.88
| Facility | | $40.07 | $376.80 | $602.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.09 / $33.68 / $33.68
| Professional | | $12.09 | $33.68 | $33.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.48 / $18.30 / $67.38
| Facility | | $13.48 | $18.30 | $67.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.41 / $19.82 / $24.78
| Professional | | $16.41 | $19.82 | $24.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.23 / $33.68 / $35.70
| Facility | | $16.23 | $33.68 | $35.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.27 / $18.13 / $20.72
| Professional | | $17.27 | $18.13 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.27 / $17.27 / $17.27
| Professional | | $17.27 | $17.27 | $17.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.91 / $37.13 / $62.17
| Facility | | $25.91 | $37.13 | $62.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.68 / $29.68 / $30.45
| Professional | | $14.68 | $29.68 | $30.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $7.25 / $20.72
| Professional | | $7.25 | $7.25 | $20.72 |