- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.86 / $33.86 / $84.65
| Facility | | $33.86 | $33.86 | $84.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $27.43 / $33.86
| Professional | | $27.43 | $27.43 | $33.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.77 / $45.20 / $251.03
| Facility | | $32.77 | $45.20 | $251.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.54 / $13.54 / $28.71
| Professional | | $13.54 | $13.54 | $28.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.35 / $35.81 / $72.23
| Facility | | $35.35 | $35.81 | $72.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.78 / $35.84 / $49.04
| Professional | | $33.78 | $35.84 | $49.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.86 / $33.86 / $41.00
| Professional | | $33.86 | $33.86 | $41.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.86 / $33.86 / $84.65
| Facility | | $33.86 | $33.86 | $84.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $27.43 / $33.86
| Professional | | $27.43 | $27.43 | $33.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.29 / $20.32 / $49.04
| Professional | | $20.29 | $20.32 | $49.04 |