- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $107.15 / $194.98
| Facility | | $32.36 | $107.15 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $32.36 / $53.70
| Professional | | $25.70 | $32.36 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $42.66 / $158.49
| Facility | | $28.84 | $42.66 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $29.51 / $69.18
| Professional | | $19.95 | $29.51 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $30.90 / $30.90
| Facility | | $21.38 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $34.67
| Professional | | $23.44 | $23.44 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $23.44 / $42.66
| Professional | | $5.13 | $23.44 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $35.48 / $43.65
| Facility | | $17.78 | $35.48 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $17.78 / $61.66
| Professional | | $14.13 | $17.78 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $23.44 / $23.44
| Professional | | $10.72 | $23.44 | $23.44 |