- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.96 / $31.86 / $56.94
| Professional | | $28.96 | $31.86 | $56.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.68 / $101.33 / $160.53
| Facility | | $26.68 | $101.33 | $160.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.73 / $27.26 / $180.66
| Professional | | $18.73 | $27.26 | $180.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.94 / $31.94 / $31.94
| Facility | | $31.94 | $31.94 | $31.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.94 / $31.94 / $31.94
| Professional | | $31.94 | $31.94 | $31.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.87 / $37.58 / $41.43
| Facility | | $31.87 | $37.58 | $41.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.08 / $36.59 / $38.86
| Professional | | $34.08 | $36.59 | $38.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.08 / $36.59 / $38.86
| Professional | | $34.08 | $36.59 | $38.86 |