- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.31 / $51.31 / $102.62
| Facility | | $51.31 | $51.31 | $102.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.31 / $51.31 / $51.31
| Professional | | $51.31 | $51.31 | $51.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.58 / $44.39 / $59.72
| Facility | | $36.58 | $44.39 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.68 / $38.47 / $45.41
| Professional | | $31.68 | $38.47 | $45.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.35 / $43.36 / $161.22
| Facility | | $40.35 | $43.36 | $161.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.31 / $51.31 / $51.31
| Professional | | $51.31 | $51.31 | $51.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.55 / $27.62 / $51.33
| Professional | | $21.55 | $27.62 | $51.33 |