- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.43 / $44.43 / $89.54
| Facility | | $44.43 | $44.43 | $89.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.88 / $44.43 / $44.43
| Professional | | $38.88 | $44.43 | $44.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.09 / $134.53 / $151.72
| Facility | | $94.09 | $134.53 | $151.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.99 / $24.99 / $55.54
| Professional | | $24.99 | $24.99 | $55.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.20 / $77.06 / $145.90
| Facility | | $42.20 | $77.06 | $145.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.84 / $64.02 / $80.02
| Professional | | $25.84 | $64.02 | $80.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.77 / $55.54 / $66.09
| Facility | | $27.77 | $55.54 | $66.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.10 / $55.54 / $614.90
| Professional | | $36.10 | $55.54 | $614.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.33 / $27.77 / $55.54
| Professional | | $23.33 | $27.77 | $55.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.10 / $263.82 / $263.82
| Facility | | $90.10 | $263.82 | $263.82 |