- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.78 / $102.85 / $166.60
| Facility | | $25.78 | $102.85 | $166.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.11 / $27.73 / $51.00
| Professional | | $23.11 | $27.73 | $51.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.81 / $140.51 / $265.54
| Facility | | $66.81 | $140.51 | $265.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.15 / $33.88 / $58.70
| Professional | | $28.15 | $33.88 | $58.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.83 / $331.26 / $534.71
| Facility | | $107.83 | $331.26 | $534.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.27 / $35.52 / $63.35
| Professional | | $25.27 | $35.52 | $63.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.75 / $42.00 / $74.86
| Facility | | $27.75 | $42.00 | $74.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.45 / $113.45 / $113.45
| Professional | | $113.45 | $113.45 | $113.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.48 / $34.77 / $51.41
| Professional | | $25.48 | $34.77 | $51.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.97 / $108.97 / $123.98
| Facility | | $108.97 | $108.97 | $123.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.88 / $34.83 / $58.42
| Professional | | $23.88 | $34.83 | $58.42 |