- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $35.48 / $144.54
| Facility | | $34.67 | $35.48 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.88 / $41.69
| Professional | | $33.11 | $33.88 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.88 / $43.65 / $436.52
| Facility | | $21.88 | $43.65 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $42.66 / $46.77
| Professional | | $34.67 | $42.66 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $33.88 / $33.88
| Facility | | $32.36 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $38.90 / $100.00
| Facility | | $22.39 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $33.88 / $72.44
| Facility | | $32.36 | $33.88 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.88 / $38.02
| Professional | | $32.36 | $33.88 | $38.02 |