- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.56 / $94.57 / $138.96
| Facility | | $49.56 | $94.57 | $138.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.32 / $46.78 / $69.62
| Professional | | $46.32 | $46.78 | $69.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.57 / $104.27 / $230.91
| Facility | | $30.57 | $104.27 | $230.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.46 / $50.02 / $55.52
| Professional | | $44.46 | $50.02 | $55.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.32 / $46.32 / $57.97
| Facility | | $46.32 | $46.32 | $57.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.32 / $46.32 / $46.32
| Professional | | $46.32 | $46.32 | $46.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.74 / $59.52 / $106.86
| Facility | | $52.74 | $59.52 | $106.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.74 / $52.74 / $102.41
| Professional | | $52.74 | $52.74 | $102.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.32 / $46.32 / $64.84
| Facility | | $46.32 | $46.32 | $64.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.32 / $46.32 / $49.10
| Professional | | $46.32 | $46.32 | $49.10 |