- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.28 / $55.28 / $59.22
| Facility | | $55.28 | $55.28 | $59.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.28 / $55.28 / $55.28
| Professional | | $55.28 | $55.28 | $55.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.73 / $96.21 / $187.61
| Facility | | $73.73 | $96.21 | $187.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.65 / $127.31 / $137.37
| Professional | | $63.65 | $127.31 | $137.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.23 / $152.10 / $190.13
| Professional | | $96.23 | $152.10 | $190.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.26 / $99.50 / $397.86
| Facility | | $50.26 | $99.50 | $397.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.26 / $50.26 / $167.52
| Professional | | $50.26 | $50.26 | $167.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.59 / $153.18 / $172.55
| Facility | | $100.59 | $153.18 | $172.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.59 / $164.84 / $218.61
| Professional | | $100.59 | $164.84 | $218.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.76 / $83.76 / $100.51
| Facility | | $83.76 | $83.76 | $100.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.74 / $50.26 / $92.14
| Professional | | $47.74 | $50.26 | $92.14 |