- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.48 / $24.48 / $24.48
| Facility | | $24.48 | $24.48 | $24.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.28 / $24.48 / $25.91
| Professional | | $16.28 | $24.48 | $25.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.18 / $35.22 / $49.06
| Facility | | $30.18 | $35.22 | $49.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $33.47 / $35.22
| Professional | | $28.18 | $33.47 | $35.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.27 / $108.63 / $301.70
| Facility | | $24.27 | $108.63 | $301.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.88 / $43.33 / $51.91
| Professional | | $40.88 | $43.33 | $51.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.48 / $104.22 / $237.56
| Facility | | $64.48 | $104.22 | $237.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.88 / $40.88 / $42.00
| Professional | | $40.88 | $40.88 | $42.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.44 / $35.22 / $164.13
| Facility | | $10.44 | $35.22 | $164.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $17.44 / $38.56
| Professional | | $10.47 | $17.44 | $38.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $17.57 / $45.80
| Professional | | $10.47 | $17.57 | $45.80 |