- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.47 / $144.97 / $633.63
| Facility | | $37.47 | $144.97 | $633.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $22.09 / $30.87
| Professional | | $18.07 | $22.09 | $30.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.28 / $74.59 / $118.21
| Facility | | $27.28 | $74.59 | $118.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $10.84 / $22.30
| Professional | | $10.84 | $10.84 | $22.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.10 / $24.67 / $66.45
| Facility | | $15.10 | $24.67 | $66.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.86 / $26.02 / $30.97
| Professional | | $16.86 | $26.02 | $30.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.62 / $30.97 / $50.86
| Facility | | $19.62 | $30.97 | $50.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.29 / $33.54 / $95.24
| Professional | | $17.29 | $33.54 | $95.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.47 / $32.47 / $32.47
| Facility | | $32.47 | $32.47 | $32.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $15.15 / $25.81
| Professional | | $10.84 | $15.15 | $25.81 |