- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.31 / $22.31 / $25.02
| Facility | | $22.31 | $22.31 | $25.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.77 / $24.02 / $31.69
| Professional | | $19.77 | $24.02 | $31.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.86 / $112.86 / $112.86
| Facility | | $112.86 | $112.86 | $112.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.47 / $37.53 / $145.31
| Professional | | $21.47 | $37.53 | $145.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.21 / $58.70 / $69.79
| Facility | | $26.21 | $58.70 | $69.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.28 / $33.83 / $58.23
| Professional | | $22.28 | $33.83 | $58.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $28.26 / $68.54
| Professional | | $18.00 | $28.26 | $68.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.07 / $29.07 / $30.55
| Facility | | $29.07 | $29.07 | $30.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.18 / $29.07 / $43.36
| Professional | | $17.18 | $29.07 | $43.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.58 / $51.14 / $72.59
| Professional | | $24.58 | $51.14 | $72.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.14 / $364.14 / $364.14
| Professional | | $364.14 | $364.14 | $364.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.86 / $112.86 / $112.86
| Facility | | $112.86 | $112.86 | $112.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.47 / $33.36 / $161.06
| Professional | | $21.47 | $33.36 | $161.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.76 / $28.34 / $70.69
| Professional | | $20.76 | $28.34 | $70.69 |