- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.64 / $37.74 / $373.07
| Facility | | $16.64 | $37.74 | $373.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.85 / $37.74 / $37.74
| Professional | | $36.85 | $37.74 | $37.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.52 / $35.52 / $35.52
| Professional | | $35.52 | $35.52 | $35.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.74 / $37.74 / $37.74
| Facility | | $37.74 | $37.74 | $37.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.74 / $37.74 / $37.74
| Professional | | $37.74 | $37.74 | $37.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.03 / $77.11 / $192.29
| Professional | | $74.03 | $77.11 | $192.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.86 / $44.40 / $87.60
| Facility | | $31.86 | $44.40 | $87.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.15 / $37.00 / $47.36
| Facility | | $35.15 | $37.00 | $47.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.15 / $37.00 / $47.36
| Professional | | $35.15 | $37.00 | $47.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $37.00 / $46.44
| Professional | | $36.40 | $37.00 | $46.44 |