- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.03 / $130.57 / $213.14
| Facility | | $17.03 | $130.57 | $213.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.79 / $13.79 / $23.38
| Professional | | $13.79 | $13.79 | $23.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.48 / $22.74 / $144.57
| Facility | | $16.48 | $22.74 | $144.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.81 / $6.81 / $16.52
| Professional | | $6.81 | $6.81 | $16.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.57 / $23.87 / $32.71
| Facility | | $19.57 | $23.87 | $32.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $19.82 / $24.82
| Professional | | $17.35 | $19.82 | $24.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.38 / $114.38 / $114.38
| Facility | | $114.38 | $114.38 | $114.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.37 / $17.37 / $164.71
| Professional | | $17.37 | $17.37 | $164.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.03 / $17.03 / $20.62
| Professional | | $17.03 | $17.03 | $20.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.03 / $120.15 / $204.05
| Facility | | $17.03 | $120.15 | $204.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.79 / $18.73 / $33.92
| Professional | | $13.79 | $18.73 | $33.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.22 / $11.68 / $28.22
| Professional | | $10.22 | $11.68 | $28.22 |