- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.84 / $67.22 / $95.25
| Professional | | $35.84 | $67.22 | $95.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.77 / $108.77 / $108.77
| Professional | | $108.77 | $108.77 | $108.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.69 / $107.69 / $107.69
| Facility | | $107.69 | $107.69 | $107.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.15 / $39.15 / $39.15
| Professional | | $39.15 | $39.15 | $39.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.65 / $147.27 / $236.03
| Professional | | $119.65 | $147.27 | $236.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.82 / $68.04 / $95.25
| Professional | | $36.82 | $68.04 | $95.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $25.00 / $25.00
| Professional | | $25.00 | $25.00 | $25.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.69 / $107.69 / $107.69
| Facility | | $107.69 | $107.69 | $107.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.15 / $39.15 / $39.15
| Professional | | $39.15 | $39.15 | $39.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.77 / $77.77 / $103.53
| Facility | | $77.77 | $77.77 | $103.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.77 / $103.53 / $103.53
| Professional | | $77.77 | $103.53 | $103.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.70 / $54.26 / $85.79
| Professional | | $40.70 | $54.26 | $85.79 |