- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.09 / $58.30 / $216.32
| Facility | | $35.09 | $58.30 | $216.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $27.37 / $49.71
| Professional | | $19.64 | $27.37 | $49.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $17.55 / $17.55
| Professional | | $17.55 | $17.55 | $17.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.62 / $35.09 / $43.86
| Facility | | $15.62 | $35.09 | $43.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.32 / $17.32 / $27.65
| Professional | | $17.32 | $17.32 | $27.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.81 / $41.06 / $127.05
| Facility | | $22.81 | $41.06 | $127.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.54 / $26.98 / $50.88
| Professional | | $25.54 | $26.98 | $50.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $12.06 / $36.84
| Professional | | $12.06 | $12.06 | $36.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $12.06 / $12.06
| Professional | | $12.06 | $12.06 | $12.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $21.05 / $55.13
| Professional | | $14.74 | $21.05 | $55.13 |