- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $83.18
| Facility | | $32.36 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $138.04
| Professional | | $32.36 | $42.66 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $89.13 / $104.71
| Professional | | $67.61 | $89.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $67.61
| Professional | | $52.48 | $52.48 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $54.95 / $218.78
| Facility | | $32.36 | $54.95 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $32.36 / $79.43
| Professional | | $22.91 | $32.36 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $46.77 / $77.62
| Professional | | $22.91 | $46.77 | $77.62 |