- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.54 / $117.82 / $156.53
| Professional | | $55.54 | $117.82 | $156.53 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $31.36 / $138.03 / $164.25
| Professional | 25 | $31.36 | $138.03 | $164.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.33 / $81.33 / $133.84
| Professional | | $81.33 | $81.33 | $133.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.70 / $119.21 / $151.22
| Professional | | $79.70 | $119.21 | $151.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.71 / $108.71 / $108.71
| Facility | | $108.71 | $108.71 | $108.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.31 / $102.08 / $168.26
| Professional | | $60.31 | $102.08 | $168.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.13 / $106.34 / $154.56
| Professional | | $76.13 | $106.34 | $154.56 |