- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.10 / $32.10 / $93.00
| Facility | | $32.10 | $32.10 | $93.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.07 / $32.10 / $36.75
| Professional | | $28.07 | $32.10 | $36.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.11 / $65.73 / $170.32
| Facility | | $56.11 | $65.73 | $170.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.16 / $31.69 / $77.68
| Professional | | $29.16 | $31.69 | $77.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.82 / $59.76 / $80.68
| Facility | | $44.82 | $59.76 | $80.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.07 / $54.09 / $127.96
| Professional | | $39.07 | $54.09 | $127.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.35 / $33.35 / $70.43
| Facility | | $33.35 | $33.35 | $70.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.35 / $24.35 / $42.60
| Professional | | $24.35 | $24.35 | $42.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.35 / $33.35 / $33.35
| Facility | | $33.35 | $33.35 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.35 / $33.35 / $33.35
| Professional | | $24.35 | $33.35 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.65 / $17.40 / $22.81
| Professional | | $12.65 | $17.40 | $22.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.03 / $26.39 / $47.81
| Facility | | $18.03 | $26.39 | $47.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.25 / $28.12 / $40.11
| Professional | | $19.25 | $28.12 | $40.11 |