- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.82 / $34.25 / $34.25
| Professional | | $25.82 | $34.25 | $34.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.16 / $201.37 / $349.14
| Facility | | $152.16 | $201.37 | $349.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.24 / $24.24 / $24.24
| Professional | | $24.24 | $24.24 | $24.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.86 / $32.86 / $212.10
| Facility | | $32.86 | $32.86 | $212.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $22.72 / $30.99
| Professional | | $13.55 | $22.72 | $30.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.86 / $32.86 / $212.10
| Facility | | $32.86 | $32.86 | $212.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $22.72 / $30.99
| Professional | | $13.55 | $22.72 | $30.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $16.45 / $44.09
| Professional | | $11.78 | $16.45 | $44.09 |