- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.22 / $191.22 / $191.22
| Facility | | $191.22 | $191.22 | $191.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $20.69 / $43.89
| Professional | | $15.66 | $20.69 | $43.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.60 / $17.14 / $61.83
| Professional | | $13.60 | $17.14 | $61.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.19 / $27.49 / $68.95
| Professional | | $20.19 | $27.49 | $68.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.34 / $27.34 / $27.34
| Facility | | $27.34 | $27.34 | $27.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.73 / $15.18 / $45.04
| Professional | | $11.73 | $15.18 | $45.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.04 / $29.52 / $43.12
| Professional | | $23.04 | $29.52 | $43.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.56 / $28.33 / $47.91
| Professional | | $20.56 | $28.33 | $47.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.42 / $107.64 / $107.64
| Facility | | $98.42 | $107.64 | $107.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.58 / $164.61 / $220.95
| Professional | | $138.58 | $164.61 | $220.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.30 / $29.08 / $39.78
| Facility | | $20.30 | $29.08 | $39.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $29.70 / $64.84
| Professional | | $12.47 | $29.70 | $64.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.89 / $25.82 / $35.51
| Professional | | $19.89 | $25.82 | $35.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $17.51 / $56.67
| Professional | | $16.50 | $17.51 | $56.67 |