- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.26 / $22.26 / $24.04
| Facility | | $22.26 | $22.26 | $24.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.26 / $24.04 / $44.51
| Professional | | $22.26 | $24.04 | $44.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.19 / $24.19 / $30.27
| Professional | | $24.19 | $24.19 | $30.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.83 / $50.83 / $50.83
| Facility | | $50.83 | $50.83 | $50.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.14 / $40.14 / $40.14
| Facility | | $40.14 | $40.14 | $40.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.11 / $34.11 / $40.14
| Professional | | $34.11 | $34.11 | $40.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.00 / $235.45 / $235.45
| Facility | | $85.00 | $235.45 | $235.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.53 / $254.53 / $370.13
| Professional | | $254.53 | $254.53 | $370.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.55 / $35.42 / $50.83
| Facility | | $14.55 | $35.42 | $50.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.71 / $43.21 / $50.83
| Professional | | $14.71 | $43.21 | $50.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.55 / $36.38 / $50.83
| Facility | | $14.55 | $36.38 | $50.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.11 / $34.11 / $40.28
| Professional | | $34.11 | $34.11 | $40.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.78 / $27.79 / $33.96
| Professional | | $18.78 | $27.79 | $33.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.34 / $50.83 / $90.00
| Professional | | $27.34 | $50.83 | $90.00 |