- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.90 / $36.90 / $36.90
| Facility | | $36.90 | $36.90 | $36.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $30.62 / $36.90
| Professional | | $26.30 | $30.62 | $36.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.34 / $78.34 / $78.34
| Facility | | $78.34 | $78.34 | $78.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.07 / $71.16 / $88.94
| Professional | | $55.07 | $71.16 | $88.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.61 / $56.26 / $118.62
| Facility | | $37.61 | $56.26 | $118.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.56 / $31.88 / $325.62
| Professional | | $23.56 | $31.88 | $325.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.66 / $77.98 / $123.08
| Facility | | $50.66 | $77.98 | $123.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.11 / $71.98 / $102.47
| Professional | | $47.11 | $71.98 | $102.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.31 / $94.59 / $107.86
| Professional | | $57.31 | $94.59 | $107.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.48 / $24.55 / $39.26
| Professional | | $16.48 | $24.55 | $39.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.26 / $39.26 / $39.26
| Professional | | $39.26 | $39.26 | $39.26 |