- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.38 / $76.28 / $102.24
| Facility | | $43.38 | $76.28 | $102.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.45 / $36.15 / $46.35
| Professional | | $32.45 | $36.15 | $46.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.64 / $46.35 / $57.94
| Facility | | $20.64 | $46.35 | $57.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.54 / $24.27 / $34.02
| Professional | | $18.54 | $24.27 | $34.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.13 / $54.23 / $167.82
| Facility | | $30.13 | $54.23 | $167.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.37 / $48.38 / $60.47
| Professional | | $24.37 | $48.38 | $60.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $46.35 / $46.35
| Professional | | $1.30 | $46.35 | $46.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.14 / $1.14 / $19.44
| Professional | | $1.14 | $1.14 | $19.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $9.77
| Facility | | $9.77 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.16 / $19.47 / $46.35
| Professional | | $8.16 | $19.47 | $46.35 |