- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.36 / $186.19 / $595.57
| Facility | | $26.36 | $186.19 | $595.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.81 / $14.13 / $14.13
| Professional | | $11.81 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.11 / $35.11 / $35.11
| Facility | | $35.11 | $35.11 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.36
| Professional | | $11.36 | $11.36 | $11.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.36
| Facility | | $11.36 | $11.36 | $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
- $11.36 / $11.36 / $13.76
| Professional | | $11.36 | $11.36 | $13.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.36 / $28.40 / $526.24
| Facility | | $26.36 | $28.40 | $526.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.81 / $14.13 / $28.40
| Professional | | $11.81 | $14.13 | $28.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $54.87
| Professional | | $11.36 | $11.36 | $54.87 |