- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.35 / $116.14 / $413.88
| Facility | | $29.35 | $116.14 | $413.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.77 / $29.35 / $38.61
| Professional | | $23.77 | $29.35 | $38.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.92 / $22.67 / $296.82
| Facility | | $14.92 | $22.67 | $296.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.74 / $11.74 / $33.94
| Professional | | $11.74 | $11.74 | $33.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.56 / $59.63 / $62.61
| Facility | | $59.56 | $59.63 | $62.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.86 / $39.94 / $61.41
| Professional | | $33.86 | $39.94 | $61.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.35 / $29.35 / $35.54
| Professional | | $29.35 | $29.35 | $35.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.35 / $99.91 / $276.41
| Facility | | $29.35 | $99.91 | $276.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.77 / $32.28 / $38.61
| Professional | | $23.77 | $32.28 | $38.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.61 / $23.98 / $57.96
| Professional | | $17.61 | $23.98 | $57.96 |