- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.12 / $38.57 / $207.60
| Professional | | $31.12 | $38.57 | $207.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.43 / $59.42 / $82.44
| Facility | | $47.43 | $59.42 | $82.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.35 / $53.34 / $77.92
| Professional | | $35.35 | $53.34 | $77.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.47 / $57.20 / $82.44
| Facility | | $37.47 | $57.20 | $82.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.63 / $59.42 / $94.69
| Professional | | $36.63 | $59.42 | $94.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.25 / $36.86 / $65.34
| Professional | | $36.25 | $36.86 | $65.34 |