- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.25 / $39.25 / $39.25
| Facility | | $39.25 | $39.25 | $39.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.98 / $32.57 / $39.25
| Professional | | $27.98 | $32.57 | $39.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.56 / $83.56 / $83.56
| Facility | | $83.56 | $83.56 | $83.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.60 / $75.72 / $94.66
| Professional | | $58.60 | $75.72 | $94.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.01 / $66.33 / $119.37
| Facility | | $40.01 | $66.33 | $119.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.06 / $37.58 / $343.25
| Professional | | $25.06 | $37.58 | $343.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.88 / $91.52 / $130.91
| Facility | | $53.88 | $91.52 | $130.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.11 / $85.07 / $119.62
| Professional | | $50.11 | $85.07 | $119.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.18 / $100.61 / $114.72
| Professional | | $68.18 | $100.61 | $114.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.54 / $29.21 / $41.76
| Professional | | $17.54 | $29.21 | $41.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.76 / $41.76 / $41.76
| Professional | | $41.76 | $41.76 | $41.76 |