- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.53 / $54.25 / $158.69
| Facility | | $25.53 | $54.25 | $158.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.68 / $20.68 / $35.06
| Professional | | $20.68 | $20.68 | $35.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.71 / $34.08 / $258.17
| Facility | | $24.71 | $34.08 | $258.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $10.21 / $29.52
| Professional | | $10.21 | $10.21 | $29.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.44 / $35.81 / $54.44
| Facility | | $30.44 | $35.81 | $54.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.86 / $34.74 / $37.06
| Professional | | $25.86 | $34.74 | $37.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.53 / $25.53 / $30.92
| Professional | | $25.53 | $25.53 | $30.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.53 / $41.36 / $177.88
| Facility | | $25.53 | $41.36 | $177.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.68 / $25.53 / $29.78
| Professional | | $20.68 | $25.53 | $29.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.32 / $20.87 / $50.43
| Professional | | $15.32 | $20.87 | $50.43 |