- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.88 / $63.88 / $67.59
| Facility | | $63.88 | $63.88 | $67.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.94 / $49.33 / $82.58
| Professional | | $36.94 | $49.33 | $82.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.03 / $57.03 / $100.64
| Facility | | $57.03 | $57.03 | $100.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.03 / $106.50 / $133.13
| Professional | | $57.03 | $106.50 | $133.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.23 / $88.04 / $91.93
| Professional | | $81.23 | $88.04 | $91.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.48 / $117.57 / $428.17
| Facility | | $57.48 | $117.57 | $428.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.98 / $47.36 / $124.78
| Professional | | $40.98 | $47.36 | $124.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.36 / $100.64 / $124.78
| Facility | | $100.36 | $100.64 | $124.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.43 / $117.57 / $192.34
| Professional | | $82.43 | $117.57 | $192.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.98 / $45.65 / $87.09
| Professional | | $40.98 | $45.65 | $87.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.92 / $86.92 / $86.92
| Facility | | $86.92 | $86.92 | $86.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.67 / $86.92 / $86.92
| Professional | | $68.67 | $86.92 | $86.92 |