- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $74.13 / $338.84
| Professional | | $48.98 | $74.13 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $295.12 / $933.25
| Facility | | $72.44 | $295.12 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $295.12
| Professional | | $83.18 | $83.18 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $147.91 / $147.91
| Facility | | $117.49 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $120.23 / $173.78
| Professional | | $48.98 | $120.23 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $95.50
| Professional | | $70.79 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $97.72 / $190.55
| Professional | | $30.90 | $97.72 | $190.55 |