- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $645.65
| Facility | | $112.20 | $218.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $47.86 / $371.54
| Professional | | $36.31 | $47.86 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $138.04 / $380.19
| Facility | | $102.33 | $138.04 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $85.11 / $91.20
| Professional | | $44.67 | $85.11 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $107.15 / $134.90
| Professional | | $56.23 | $107.15 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $67.61 / $263.03
| Facility | | $33.88 | $67.61 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.88 / $61.66
| Professional | | $25.12 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $114.82 / $144.54
| Professional | | $56.23 | $114.82 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $50.12 / $102.33
| Facility | | $25.12 | $50.12 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $33.88 / $61.66
| Professional | | $30.20 | $33.88 | $61.66 |