- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.08 / $38.08 / $38.08
| Professional | | $38.08 | $38.08 | $38.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.77 / $35.68 / $67.47
| Professional | | $28.77 | $35.68 | $67.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.63 / $46.63 / $46.63
| Facility | | $46.63 | $46.63 | $46.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.63 / $46.63 / $46.63
| Professional | | $46.63 | $46.63 | $46.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.21 / $148.19 / $177.55
| Professional | | $140.21 | $148.19 | $177.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.24 / $58.81 / $109.03
| Professional | | $45.24 | $58.81 | $109.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.69 / $34.69 / $34.69
| Facility | | $34.69 | $34.69 | $34.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.61 / $34.69 / $67.73
| Professional | | $28.61 | $34.69 | $67.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.50 / $57.50 / $57.50
| Professional | | $57.50 | $57.50 | $57.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $555.00 / $597.00
| Facility | | $555.00 | $555.00 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $93.70
| Professional | | $45.00 | $45.00 | $93.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.46 / $36.42 / $69.75
| Professional | | $24.46 | $36.42 | $69.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.69 / $34.69 / $34.69
| Facility | | $34.69 | $34.69 | $34.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.06 / $39.44 / $67.73
| Professional | | $30.06 | $39.44 | $67.73 |