- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.78 / $100.55 / $167.15
| Professional | | $64.78 | $100.55 | $167.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.00 / $66.48 / $139.38
| Facility | | $20.00 | $66.48 | $139.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.83 / $220.70 / $350.87
| Professional | | $22.83 | $220.70 | $350.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.68 / $36.27 / $106.38
| Facility | | $16.68 | $36.27 | $106.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.32 / $22.32 / $106.38
| Professional | | $18.32 | $22.32 | $106.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.63 / $13.63 / $13.63
| Facility | | $13.63 | $13.63 | $13.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.13 / $63.26 / $105.01
| Professional | | $35.13 | $63.26 | $105.01 |