- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $165.96 / $398.11
| Facility | | $15.49 | $165.96 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $17.38 / $22.91
| Professional | | $14.13 | $17.38 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $9.77 / $13.49
| Professional | | $8.91 | $9.77 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $26.92 / $26.92
| Professional | | $14.13 | $26.92 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $46.77 / $75.86
| Facility | | $12.88 | $46.77 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.30 / $30.20
| Professional | | $8.91 | $12.30 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $13.49 / $19.50
| Facility | | $7.08 | $13.49 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $12.88 / $21.38
| Professional | | $8.32 | $12.88 | $21.38 |