- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.68 / $94.94 / $257.00
| Facility | | $58.68 | $94.94 | $257.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.15 / $43.15 / $43.15
| Professional | | $43.15 | $43.15 | $43.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.03 / $141.74 / $235.74
| Facility | | $36.03 | $141.74 | $235.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.31 / $54.26 / $77.33
| Professional | | $37.31 | $54.26 | $77.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.03 / $104.68 / $188.42
| Facility | | $43.03 | $104.68 | $188.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.93 / $78.47 / $98.09
| Professional | | $73.93 | $78.47 | $98.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.49 / $51.53 / $305.95
| Facility | | $33.49 | $51.53 | $305.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $27.05 / $51.53
| Professional | | $27.05 | $27.05 | $51.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $27.05 / $41.42
| Professional | | $27.05 | $27.05 | $41.42 |