- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.61 / $52.21 / $223.83
| Professional | | $30.61 | $52.21 | $223.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.78 / $249.10 / $570.99
| Facility | | $176.78 | $249.10 | $570.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.27 / $58.27 / $186.20
| Facility | | $58.27 | $58.27 | $186.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.29 / $60.08 / $147.26
| Professional | | $22.29 | $60.08 | $147.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.27 / $58.27 / $186.20
| Facility | | $58.27 | $58.27 | $186.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.78 / $60.08 / $147.26
| Professional | | $25.78 | $60.08 | $147.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.72 / $50.47 / $104.43
| Professional | | $21.72 | $50.47 | $104.43 |