- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.86 / $324.48 / $542.70
| Facility | | $77.86 | $324.48 | $542.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.43 / $14.68 / $20.71
| Professional | | $13.43 | $14.68 | $20.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.89 / $24.17 / $29.54
| Facility | | $17.89 | $24.17 | $29.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $22.38 / $24.17
| Professional | | $17.89 | $22.38 | $24.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.55 / $33.86 / $53.72
| Facility | | $14.55 | $33.86 | $53.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $25.81 / $97.70
| Professional | | $10.14 | $25.81 | $97.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.81 / $85.35 / $314.33
| Facility | | $68.81 | $85.35 | $314.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $10.74
| Professional | | $10.74 | $10.74 | $10.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.52 / $7.52 / $7.52
| Facility | | $7.52 | $7.52 | $7.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.51 / $10.51 / $15.01
| Professional | | $3.51 | $10.51 | $15.01 |