- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $251.19 / $776.25
| Facility | | $141.25 | $251.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $14.13 / $89.13
| Professional | | $8.91 | $14.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $25.70 / $32.36
| Professional | | $20.42 | $25.70 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $16.60 / $31.62
| Facility | | $9.77 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $16.22 / $34.67
| Professional | | $10.72 | $16.22 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $19.95
| Professional | | $19.50 | $19.50 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $18.62 / $18.62
| Professional | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $19.95 / $25.12
| Professional | | $12.88 | $19.95 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $17.38 / $25.70
| Professional | | $10.96 | $17.38 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $21.88 / $21.88
| Professional | | $16.98 | $21.88 | $21.88 |