- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.53 / $62.72 / $108.83
| Professional | | $36.53 | $62.72 | $108.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.34 / $91.73 / $166.45
| Professional | | $47.34 | $91.73 | $166.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.81 / $80.70 / $142.26
| Professional | | $46.81 | $80.70 | $142.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.04 / $85.38 / $141.47
| Facility | | $46.04 | $85.38 | $141.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.31 / $115.70 / $164.72
| Professional | | $52.31 | $115.70 | $164.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.45 / $108.03 / $171.74
| Professional | | $72.45 | $108.03 | $171.74 |