- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.50 / $58.08 / $101.00
| Facility | | $50.50 | $58.08 | $101.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.77 / $58.08 / $58.08
| Professional | | $26.77 | $58.08 | $58.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.09 / $52.30 / $70.36
| Facility | | $43.09 | $52.30 | $70.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.77 / $32.77 / $51.54
| Professional | | $32.77 | $32.77 | $51.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.22 / $51.43 / $158.13
| Facility | | $38.22 | $51.43 | $158.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.93 / $37.57 / $72.28
| Professional | | $26.93 | $37.57 | $72.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.21 / $29.64 / $70.56
| Professional | | $21.21 | $29.64 | $70.56 |