- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.75 / $44.36 / $234.67
| Professional | | $38.75 | $44.36 | $234.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.04 / $77.34 / $235.75
| Facility | | $62.04 | $77.34 | $235.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.22 / $62.57 / $121.55
| Professional | | $45.22 | $62.57 | $121.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.04 / $77.34 / $235.75
| Facility | | $62.04 | $77.34 | $235.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.60 / $53.20 / $74.20
| Professional | | $38.60 | $53.20 | $74.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.97 / $39.86 / $72.25
| Professional | | $34.97 | $39.86 | $72.25 |