- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.61 / $39.22 / $57.84
| Facility | | $31.61 | $39.22 | $57.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.61 / $35.74 / $44.52
| Professional | | $31.61 | $35.74 | $44.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.30 / $71.56 / $96.11
| Facility | | $45.30 | $71.56 | $96.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.42 / $29.42 / $38.82
| Professional | | $29.42 | $29.42 | $38.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.68 / $36.77 / $36.77
| Facility | | $34.68 | $36.77 | $36.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.77 / $36.77 / $46.14
| Professional | | $36.77 | $36.77 | $46.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.61 / $43.76 / $50.75
| Facility | | $31.61 | $43.76 | $50.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.65 / $29.65 / $29.65
| Professional | | $29.65 | $29.65 | $29.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.77 / $36.77 / $47.80
| Professional | | $36.77 | $36.77 | $47.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $183.85
| Facility | | $75.00 | $100.00 | $183.85 |