- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.33 / $33.77 / $192.78
| Professional | | $27.33 | $33.77 | $192.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.68 / $52.05 / $70.70
| Facility | | $40.68 | $52.05 | $70.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.23 / $44.18 / $73.22
| Professional | | $27.23 | $44.18 | $73.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.90 / $48.46 / $70.70
| Facility | | $32.90 | $48.46 | $70.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.03 / $52.05 / $82.96
| Professional | | $32.03 | $52.05 | $82.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.13 / $33.92 / $59.57
| Professional | | $29.13 | $33.92 | $59.57 |