- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $173.78 / $275.42
| Facility | | $31.62 | $173.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.85 / $23.44
| Professional | | $12.88 | $15.85 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $17.38 / $53.70
| Facility | | $16.98 | $17.38 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $22.91 / $38.02
| Professional | | $12.30 | $22.91 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $72.44 / $104.71
| Facility | | $19.50 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $16.60 / $17.78
| Professional | | $13.49 | $16.60 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $19.50 / $61.66
| Professional | | $13.80 | $19.50 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $19.50 / $34.67
| Professional | | $17.38 | $19.50 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $12.88
| Facility | | $9.77 | $9.77 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $11.48 / $12.88
| Professional | | $8.32 | $11.48 | $12.88 |