- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.28 / $91.19 / $91.19
| Facility | | $77.28 | $91.19 | $91.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.70 / $26.70 / $71.84
| Professional | | $19.70 | $26.70 | $71.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.05 / $45.05 / $46.20
| Professional | | $45.05 | $45.05 | $46.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.49 / $31.91 / $49.65
| Professional | | $24.49 | $31.91 | $49.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.32 / $22.32 / $22.32
| Professional | | $22.32 | $22.32 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.98 / $36.00 / $69.68
| Professional | | $28.98 | $36.00 | $69.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.90 / $28.49 / $39.13
| Professional | | $25.90 | $28.49 | $39.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.19 / $91.19 / $91.19
| Facility | | $91.19 | $91.19 | $91.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.70 / $36.04 / $91.19
| Professional | | $19.70 | $36.04 | $91.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.00 / $32.50 / $45.60
| Professional | | $26.00 | $32.50 | $45.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.32 / $22.32 / $22.32
| Professional | | $22.32 | $22.32 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.84 / $22.08 / $23.52
| Professional | | $21.84 | $22.08 | $23.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.50 / $25.29 / $39.15
| Professional | | $14.50 | $25.29 | $39.15 |