- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $38.02 / $131.83
| Professional | | $32.36 | $38.02 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $100.00 / $114.82
| Facility | | $83.18 | $100.00 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $52.48
| Professional | | $38.90 | $38.90 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $63.10
| Facility | | $47.86 | $47.86 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $47.86
| Professional | | $35.48 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $89.13
| Professional | | $74.13 | $74.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $40.74 / $131.83
| Professional | | $33.88 | $40.74 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $42.66 / $42.66
| Facility | | $20.42 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $47.86 / $74.13
| Professional | | $28.18 | $47.86 | $74.13 |