- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.22 / $212.61 / $277.29
| Facility | | $95.22 | $212.61 | $277.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.02 / $95.22 / $95.22
| Professional | | $84.02 | $95.22 | $95.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.45 / $545.54 / $688.92
| Facility | | $425.45 | $545.54 | $688.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.91 / $6.91 / $58.02
| Professional | | $6.91 | $6.91 | $58.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.81 / $324.24 / $573.67
| Facility | | $72.81 | $324.24 | $573.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.67 / $128.44 / $160.55
| Professional | | $46.67 | $128.44 | $160.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.41 / $140.03 / $165.79
| Professional | | $134.41 | $140.03 | $165.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.25 / $87.38 / $128.82
| Facility | | $58.25 | $87.38 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.86 / $112.02 / $235.24
| Professional | | $91.86 | $112.02 | $235.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.81 / $128.82 / $465.13
| Facility | | $72.81 | $128.82 | $465.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.30 / $129.94 / $465.13
| Professional | | $78.30 | $129.94 | $465.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.05 / $56.01 / $84.02
| Professional | | $47.05 | $56.01 | $84.02 |