- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $32.36 / $52.48
| Professional | | $26.92 | $32.36 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $102.33
| Facility | | $63.10 | $63.10 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $57.54 / $69.18
| Professional | | $56.23 | $57.54 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $144.54 / $309.03
| Facility | | $36.31 | $144.54 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $89.13 / $117.49
| Professional | | $26.92 | $89.13 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $77.62
| Facility | | $30.20 | $50.12 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $87.10 / $109.65
| Professional | | $56.23 | $87.10 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $61.66 / $288.40
| Facility | | $30.90 | $61.66 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $32.36 / $69.18
| Professional | | $26.92 | $32.36 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $58.88 / $70.79
| Professional | | $20.89 | $58.88 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $93.33 / $169.82
| Professional | | $63.10 | $93.33 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $123.03 / $288.40
| Facility | | $36.31 | $123.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $53.70 / $309.03
| Professional | | $26.92 | $53.70 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $31.62 / $89.13
| Facility | | $25.12 | $31.62 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $30.90 / $52.48
| Professional | | $21.38 | $30.90 | $52.48 |