- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $40.74 / $81.28
| Professional | | $32.36 | $40.74 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $56.23 / $107.15
| Professional | | $46.77 | $56.23 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $50.12
| Facility | | $44.67 | $44.67 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $44.67 / $81.28
| Professional | | $21.88 | $44.67 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $43.65 / $81.28
| Professional | | $21.88 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $60.26 / $114.82
| Professional | | $39.81 | $60.26 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $48.98 / $77.62
| Professional | | $29.51 | $48.98 | $77.62 |