- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.05 / $32.47 / $623.88
| Facility | | $20.05 | $32.47 | $623.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $16.23 / $23.42
| Professional | | $16.23 | $16.23 | $23.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.39 / $26.77 / $202.75
| Facility | | $19.39 | $26.77 | $202.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.02 / $8.02 / $23.19
| Professional | | $8.02 | $8.02 | $23.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.78 / $27.98 / $42.76
| Facility | | $23.78 | $27.98 | $42.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.86 / $23.13 / $29.02
| Professional | | $17.86 | $23.13 | $29.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.05 / $20.05 / $20.25
| Professional | | $20.05 | $20.05 | $20.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.05 / $20.05 / $623.88
| Facility | | $20.05 | $20.05 | $623.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $20.05 / $23.42
| Professional | | $16.23 | $20.05 | $23.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.03 / $16.39 / $39.61
| Professional | | $12.03 | $16.39 | $39.61 |