- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.08 / $266.17 / $445.78
| Facility | | $57.08 | $266.17 | $445.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.01 / $129.21 / $129.21
| Professional | | $23.01 | $129.21 | $129.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.55 / $106.55 / $106.55
| Facility | | $106.55 | $106.55 | $106.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.14 / $44.19 / $55.24
| Professional | | $20.14 | $44.19 | $55.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.58 / $13.58 / $13.58
| Facility | | $13.58 | $13.58 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.57 / $38.57 / $154.28
| Professional | | $38.57 | $38.57 | $154.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.00 / $142.71 / $154.28
| Facility | | $135.00 | $142.71 | $154.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.71 / $57.86 / $154.28
| Professional | | $34.71 | $57.86 | $154.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.58 / $13.58 / $13.58
| Facility | | $13.58 | $13.58 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.64 / $38.57 / $106.07
| Professional | | $36.64 | $38.57 | $106.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.36 / $77.14 / $116.37
| Professional | | $17.36 | $77.14 | $116.37 |