- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.68 / $35.39 / $35.39
| Professional | | $26.68 | $35.39 | $35.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.22 / $245.32 / $361.17
| Facility | | $157.22 | $245.32 | $361.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.04 / $25.04 / $25.04
| Professional | | $25.04 | $25.04 | $25.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.94 / $33.94 / $258.39
| Facility | | $33.94 | $33.94 | $258.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.06 / $23.54 / $32.21
| Professional | | $14.06 | $23.54 | $32.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.94 / $33.94 / $258.39
| Facility | | $33.94 | $33.94 | $258.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.06 / $23.54 / $32.21
| Professional | | $14.06 | $23.54 | $32.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.86 / $17.00 / $39.68
| Professional | | $8.86 | $17.00 | $39.68 |