- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.72 / $64.09 / $563.04
| Facility | | $13.72 | $64.09 | $563.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.72 / $13.72 / $16.94
| Professional | | $13.72 | $13.72 | $16.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.39 / $22.61 / $171.37
| Facility | | $16.39 | $22.61 | $171.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.78 / $6.78 / $19.59
| Professional | | $6.78 | $6.78 | $19.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.98 / $23.50 / $36.13
| Facility | | $19.98 | $23.50 | $36.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $23.05 / $24.47
| Professional | | $17.02 | $23.05 | $24.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.94 / $16.94 / $20.51
| Professional | | $16.94 | $16.94 | $20.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.94 / $71.89 / $546.26
| Facility | | $16.94 | $71.89 | $546.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.72 / $16.94 / $19.76
| Professional | | $13.72 | $16.94 | $19.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $13.84 / $33.45
| Professional | | $10.16 | $13.84 | $33.45 |