- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.23 / $116.71 / $259.07
| Facility | | $16.23 | $116.71 | $259.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $26.94 / $119.26
| Professional | | $16.23 | $26.94 | $119.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $31.33 / $39.17
| Professional | | $19.82 | $31.33 | $39.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.55 / $41.10 / $120.77
| Facility | | $16.55 | $41.10 | $120.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.81 / $10.36 / $20.72
| Professional | | $8.81 | $10.36 | $20.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $30.22 / $31.77
| Facility | | $20.72 | $30.22 | $31.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $28.98 / $31.77
| Professional | | $20.72 | $28.98 | $31.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.27 / $41.61 / $47.44
| Professional | | $17.27 | $41.61 | $47.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $10.36 / $20.72
| Professional | | $7.25 | $10.36 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.27 / $17.27 / $17.27
| Professional | | $17.27 | $17.27 | $17.27 |