- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.61 / $97.34 / $208.82
| Facility | | $47.61 | $97.34 | $208.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $28.07 / $40.68
| Professional | | $22.02 | $28.07 | $40.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $21.05 / $35.09
| Professional | | $17.55 | $21.05 | $35.09 |
- 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 / $30.01
| Professional | | $17.32 | $17.32 | $30.01 |
- 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
- $24.12 / $26.98 / $50.88
| Professional | | $24.12 | $26.98 | $50.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $11.97 / $36.84
| Professional | | $11.97 | $11.97 | $36.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $11.97 / $11.97
| Professional | | $11.97 | $11.97 | $11.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $30.00 / $55.13
| Professional | | $14.74 | $30.00 | $55.13 |