- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.82 / $20.82 / $22.48
| Facility | | $20.82 | $20.82 | $22.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.82 / $22.48 / $41.63
| Professional | | $20.82 | $22.48 | $41.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.63 / $28.31 / $28.31
| Professional | | $22.63 | $28.31 | $28.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.54 / $47.54 / $47.54
| Facility | | $47.54 | $47.54 | $47.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.59 / $30.59 / $30.59
| Facility | | $30.59 | $30.59 | $30.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.33 / $22.33 / $30.59
| Professional | | $22.33 | $22.33 | $30.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.00 / $220.66 / $220.66
| Facility | | $85.00 | $220.66 | $220.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.99 / $237.99 / $346.20
| Professional | | $237.99 | $237.99 | $346.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.61 / $37.21 / $47.54
| Facility | | $24.61 | $37.21 | $47.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.01 / $42.79 / $47.94
| Professional | | $31.01 | $42.79 | $47.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.77 / $31.79 / $47.54
| Facility | | $26.77 | $31.79 | $47.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.33 / $22.33 / $38.38
| Professional | | $22.33 | $22.33 | $38.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.98 / $47.98 / $56.45
| Facility | | $47.98 | $47.98 | $56.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.60 / $26.40 / $34.36
| Professional | | $17.60 | $26.40 | $34.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.98 / $28.62 / $47.54
| Professional | | $27.98 | $28.62 | $47.54 |