- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.89 / $98.35 / $208.30
| Facility | | $17.89 | $98.35 | $208.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $20.45 / $20.81
| Professional | | $17.89 | $20.45 | $20.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.66 / $51.62 / $234.09
| Facility | | $21.66 | $51.62 | $234.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $22.94 / $32.22
| Professional | | $11.58 | $22.94 | $32.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $66.50 / $138.28
| Facility | | $41.69 | $66.50 | $138.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.67 / $14.46 / $33.04
| Professional | | $11.67 | $14.46 | $33.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.71 / $20.65 / $42.89
| Facility | | $11.71 | $20.65 | $42.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.01 / $25.00 / $34.69
| Professional | | $12.01 | $25.00 | $34.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.62 / $12.62 / $18.17
| Professional | | $12.62 | $12.62 | $18.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.44 / $13.08 / $32.06
| Professional | | $6.44 | $13.08 | $32.06 |