- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $77.62 / $177.83
| Facility | | $56.23 | $77.62 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $151.36 / $741.31 / $2,290.87
| Facility | 25 | $151.36 | $741.31 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $83.18 / $204.17
| Professional | | $57.54 | $83.18 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $89.13 / $223.87
| Facility | | $70.79 | $89.13 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $87.10 / $154.88
| Professional | | $54.95 | $87.10 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $707.95
| Facility | | $125.89 | $245.47 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $102.33 / $223.87
| Professional | | $69.18 | $102.33 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $85.11 / $102.33
| Facility | | $70.79 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $83.18 / $151.36
| Professional | | $60.26 | $83.18 | $151.36 |