- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.54 / $68.31 / $94.06
| Professional | | $38.54 | $68.31 | $94.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.40 / $97.30 / $133.61
| Professional | | $57.40 | $97.30 | $133.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.72 / $90.58 / $131.30
| Professional | | $53.72 | $90.58 | $131.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.65 / $76.40 / $121.27
| Facility | | $48.65 | $76.40 | $121.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.00 / $98.06 / $373.15
| Professional | | $81.00 | $98.06 | $373.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.54 / $87.74 / $108.38
| Professional | | $55.54 | $87.74 | $108.38 |