- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.47 / $53.47 / $133.68
| Facility | | $53.47 | $53.47 | $133.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.31 / $43.31 / $53.47
| Professional | | $43.31 | $43.31 | $53.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.74 / $71.38 / $184.85
| Facility | | $51.74 | $71.38 | $184.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.39 / $21.39 / $34.75
| Professional | | $21.39 | $21.39 | $34.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.54 / $37.54 / $114.06
| Facility | | $37.54 | $37.54 | $114.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.83 / $53.48 / $56.69
| Professional | | $33.83 | $53.48 | $56.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.47 / $53.47 / $54.00
| Professional | | $53.47 | $53.47 | $54.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.47 / $53.47 / $133.68
| Facility | | $53.47 | $53.47 | $133.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.31 / $53.47 / $53.47
| Professional | | $43.31 | $53.47 | $53.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.40 / $32.08 / $47.62
| Professional | | $13.40 | $32.08 | $47.62 |