- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.07 / $100.53 / $257.06
| Facility | | $48.07 | $100.53 | $257.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.54 / $26.69 / $26.69
| Professional | | $21.54 | $26.69 | $26.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.06 / $64.06 / $64.06
| Facility | | $64.06 | $64.06 | $64.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Facility | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $25.09
| Professional | | $20.72 | $20.72 | $25.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.07 / $56.10 / $178.66
| Facility | | $48.07 | $56.10 | $178.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $26.69 / $51.80
| Professional | | $21.53 | $26.69 | $51.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.83 / $20.72 / $32.39
| Professional | | $15.83 | $20.72 | $32.39 |