- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.07 / $51.07 / $127.68
| Facility | | $51.07 | $51.07 | $127.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.37 / $51.07 / $76.59
| Professional | | $41.37 | $51.07 | $76.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.42 / $68.18 / $197.46
| Facility | | $49.42 | $68.18 | $197.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.43 / $20.43 / $33.19
| Professional | | $20.43 | $20.43 | $33.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.95 / $108.95 / $108.95
| Facility | | $108.95 | $108.95 | $108.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.46 / $51.72 / $54.13
| Professional | | $32.46 | $51.72 | $54.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.07 / $51.07 / $51.58
| Professional | | $51.07 | $51.07 | $51.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.07 / $51.07 / $127.68
| Facility | | $51.07 | $51.07 | $127.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.37 / $51.07 / $58.46
| Professional | | $41.37 | $51.07 | $58.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.05 / $30.64 / $76.61
| Professional | | $26.05 | $30.64 | $76.61 |