- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $83.18 / $177.83
| Professional | | $44.67 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $67.61 / $107.15 / $245.47
| Professional | 25 | $67.61 | $107.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $87.10 / $144.54
| Professional | | $74.13 | $87.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $72.44 / $158.49
| Professional | | $40.74 | $72.44 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $74.13 / $120.23
| Facility | | $44.67 | $74.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $79.43 / $141.25
| Professional | | $72.44 | $79.43 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $53.70 / $93.33
| Professional | | $33.11 | $53.70 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $724.44
| Professional | | $562.34 | $562.34 | $724.44 |