- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $38.02 / $81.28
| Facility | | $10.47 | $38.02 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $32.36 / $64.57
| Professional | | $30.20 | $32.36 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $24.55 / $33.88
| Professional | | $8.71 | $24.55 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $83.18
| Facility | | $61.66 | $61.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $31.62
| Professional | | $23.44 | $23.44 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $36.31
| Professional | | $33.88 | $33.88 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $33.88 / $38.90
| Facility | | $32.36 | $33.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $36.31 / $40.74
| Professional | | $33.88 | $36.31 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |