- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.36 / $79.23 / $507.56
| Professional | | $59.36 | $79.23 | $507.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.32 / $103.32 / $103.32
| Facility | | $103.32 | $103.32 | $103.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.42 / $75.42 / $103.32
| Professional | | $75.42 | $75.42 | $103.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.36 / $279.11 / $364.05
| Professional | | $92.36 | $279.11 | $364.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.14 / $108.42 / $135.13
| Facility | | $79.14 | $108.42 | $135.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.10 / $124.02 / $138.54
| Professional | | $98.10 | $124.02 | $138.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.73 / $131.94 / $171.81
| Facility | | $104.73 | $131.94 | $171.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.73 / $131.94 / $171.81
| Professional | | $104.73 | $131.94 | $171.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.14 / $113.32 / $138.54
| Facility | | $79.14 | $113.32 | $138.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.42 / $115.53 / $145.13
| Professional | | $75.42 | $115.53 | $145.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.92 / $219.40 / $462.88
| Facility | | $109.92 | $219.40 | $462.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.47 / $145.13 / $145.13
| Professional | | $113.47 | $145.13 | $145.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.63 / $65.81 / $126.16
| Professional | | $62.63 | $65.81 | $126.16 |