- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.22 / $42.63 / $46.23
| Professional | | $31.22 | $42.63 | $46.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.96 / $35.96 / $40.67
| Professional | | $26.96 | $35.96 | $40.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.33 / $31.33 / $34.46
| Professional | | $31.33 | $31.33 | $34.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.24 / $43.24 / $43.24
| Facility | | $43.24 | $43.24 | $43.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.85 / $180.85 / $180.85
| Professional | | $180.85 | $180.85 | $180.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.15 / $40.06 / $51.26
| Professional | | $33.15 | $40.06 | $51.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.22 / $42.27 / $56.86
| Facility | | $31.22 | $42.27 | $56.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $58.73 / $90.98
| Professional | | $50.00 | $58.73 | $90.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.84 / $46.57 / $87.45
| Facility | | $36.84 | $46.57 | $87.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.84 / $46.57 / $87.45
| Professional | | $36.84 | $46.57 | $87.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.41 / $34.79 / $61.23
| Professional | | $27.41 | $34.79 | $61.23 |