- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.55 / $36.31 / $89.13
| Facility | | $24.55 | $36.31 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $19.05 / $30.20
| Professional | | $12.88 | $19.05 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $51.29 / $75.86
| Facility | | $31.62 | $51.29 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $19.50 / $35.48
| Professional | | $13.80 | $19.50 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $42.66 / $50.12
| Professional | | $19.50 | $42.66 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $26.92
| Facility | | $19.50 | $19.50 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $23.44 / $34.67
| Professional | | $19.50 | $23.44 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $56.23
| Facility | | $19.50 | $19.50 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $28.18 / $75.86
| Facility | | $19.05 | $28.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $24.55 / $79.43
| Professional | | $19.50 | $24.55 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $58.88 / $81.28
| Facility | | $29.51 | $58.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $19.50 / $26.92
| Professional | | $14.79 | $19.50 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $31.62
| Facility | | $23.44 | $23.44 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $12.02 / $27.54
| Professional | | $8.32 | $12.02 | $27.54 |