- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.36 / $95.05 / $257.95
| Facility | | $16.36 | $95.05 | $257.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.27 / $15.27 / $148.72
| Professional | | $15.27 | $15.27 | $148.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $39.40 / $76.83
| Facility | | $30.20 | $39.40 | $76.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.57 / $35.15 / $37.93
| Professional | | $17.57 | $35.15 | $37.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $33.56 / $53.04
| Professional | | $17.05 | $33.56 | $53.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $44.30 / $182.22
| Facility | | $13.88 | $44.30 | $182.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.88 / $13.88 / $57.00
| Professional | | $13.88 | $13.88 | $57.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.05 / $29.85 / $64.06
| Facility | | $17.05 | $29.85 | $64.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.46 / $36.11 / $52.00
| Professional | | $22.46 | $36.11 | $52.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.41 / $13.88 / $46.26
| Professional | | $10.41 | $13.88 | $46.26 |