- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.64 / $47.64 / $878.88
| Facility | | $47.64 | $47.64 | $878.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.64 / $47.64 / $52.40
| Professional | | $47.64 | $47.64 | $52.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.30 / $138.30 / $138.30
| Facility | | $138.30 | $138.30 | $138.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.62 / $45.62 / $45.62
| Professional | | $45.62 | $45.62 | $45.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.10 / $50.10 / $50.10
| Facility | | $50.10 | $50.10 | $50.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.10 / $50.10 / $50.10
| Professional | | $50.10 | $50.10 | $50.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.50 / $52.64 / $80.76
| Professional | | $45.50 | $52.64 | $80.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.64 / $132.86 / $878.88
| Facility | | $47.64 | $132.86 | $878.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.64 / $47.64 / $68.86
| Professional | | $47.64 | $47.64 | $68.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $44.73 / $64.86
| Professional | | $38.02 | $44.73 | $64.86 |