- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.26 / $89.53 / $104.26
| Facility | | $19.26 | $89.53 | $104.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.75 / $20.48 / $24.08
| Professional | | $12.75 | $20.48 | $24.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.72 / $16.72 / $16.72
| Professional | | $16.72 | $16.72 | $16.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.79 / $50.24 / $78.72
| Facility | | $40.79 | $50.24 | $78.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.05 / $21.76 / $21.76
| Professional | | $18.05 | $21.76 | $21.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.03 / $33.72 / $63.16
| Facility | | $19.03 | $33.72 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.43 / $25.13 / $31.41
| Professional | | $21.43 | $25.13 | $31.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.54 / $19.26 / $31.33
| Facility | | $17.54 | $19.26 | $31.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.32 / $32.50 / $33.03
| Professional | | $19.32 | $32.50 | $33.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.04 / $16.25 / $32.50
| Professional | | $12.04 | $16.25 | $32.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.70 / $114.38 / $114.38
| Facility | | $51.70 | $114.38 | $114.38 |