- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.57 / $121.57 / $175.14
| Facility | | $121.57 | $121.57 | $175.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.15 / $131.35 / $131.35
| Professional | | $47.15 | $131.35 | $131.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.67 / $71.36 / $262.68
| Facility | | $65.67 | $71.36 | $262.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.37 / $77.23 / $96.54
| Professional | | $41.37 | $77.23 | $96.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.32 / $117.64 / $137.91
| Facility | | $63.32 | $117.64 | $137.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.36 / $67.36 / $80.83
| Professional | | $67.36 | $67.36 | $80.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.04 / $151.56 / $247.88
| Facility | | $101.04 | $151.56 | $247.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.26 / $115.82 / $118.27
| Professional | | $57.26 | $115.82 | $118.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.29 / $40.07 / $137.84
| Professional | | $28.29 | $40.07 | $137.84 |