- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.89 / $18.18 / $18.18
| Facility | | $17.89 | $18.18 | $18.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.86 / $16.89 / $22.72
| Professional | | $13.86 | $16.89 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.63 / $108.63 / $108.63
| Facility | | $108.63 | $108.63 | $108.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.86 / $41.28 / $142.72
| Professional | | $20.86 | $41.28 | $142.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.17 / $190.11 / $226.06
| Facility | | $25.17 | $190.11 | $226.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.76 / $36.22 / $56.87
| Professional | | $21.76 | $36.22 | $56.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.00 / $95.00 / $95.00
| Facility | | $95.00 | $95.00 | $95.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.42 / $31.86 / $75.48
| Professional | | $19.42 | $31.86 | $75.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.41 / $28.41 / $28.41
| Facility | | $28.41 | $28.41 | $28.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.32 / $24.53 / $42.85
| Professional | | $13.32 | $24.53 | $42.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.98 / $46.71 / $65.76
| Professional | | $22.98 | $46.71 | $65.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.48 / $123.48 / $130.79
| Facility | | $123.48 | $123.48 | $130.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.63 / $108.63 / $108.63
| Facility | | $108.63 | $108.63 | $108.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.62 / $32.42 / $142.72
| Professional | | $21.62 | $32.42 | $142.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $26.35 / $59.73
| Professional | | $21.46 | $26.35 | $59.73 |