- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $36.54 / $54.64
| Professional | | $33.88 | $36.54 | $54.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.40 / $144.21 / $236.68
| Facility | | $104.40 | $144.21 | $236.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.70 / $40.65 / $63.59
| Professional | | $35.70 | $40.65 | $63.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.45 / $55.56 / $93.99
| Professional | | $39.45 | $55.56 | $93.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.03 / $41.63 / $73.16
| Professional | | $37.03 | $41.63 | $73.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $36.54 / $63.10
| Professional | | $33.88 | $36.54 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.94 / $45.37 / $71.05
| Professional | | $30.94 | $45.37 | $71.05 |