- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.68 / $93.54 / $523.90
| Facility | | $11.68 | $93.54 | $523.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.47 / $14.13
| Professional | | $11.36 | $11.47 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.36 / $12.33 / $12.33
| Facility | | $11.36 | $12.33 | $12.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.58
| Professional | | $11.36 | $11.36 | $11.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $22.34
| Facility | | $11.36 | $11.36 | $22.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $11.36
| Facility | | $10.72 | $10.72 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.36
| Professional | | $11.36 | $11.36 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.39 / $19.54 / $53.32
| Professional | | $16.39 | $19.54 | $53.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.69 / $2,773.51 / $2,932.00
| Facility | | $2,221.69 | $2,773.51 | $2,932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $19.88
| Professional | | $11.36 | $11.36 | $19.88 |