- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $151.36
| Facility | | $33.88 | $33.88 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $26.92 / $112.20
| Professional | | $22.91 | $26.92 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $234.42 / $251.19
| Facility | | $38.90 | $234.42 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $20.42 / $33.88
| Professional | | $13.49 | $20.42 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $77.62
| Facility | | $35.48 | $35.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $34.67 / $48.98
| Professional | | $15.49 | $34.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $33.88 / $40.74
| Professional | | $20.42 | $33.88 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $54.95
| Facility | | $33.88 | $33.88 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.88 / $112.20
| Professional | | $25.12 | $33.88 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $33.88 / $52.48
| Professional | | $20.42 | $33.88 | $52.48 |