- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.36 / $61.54 / $102.30
| Professional | | $26.36 | $61.54 | $102.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.35 / $77.00 / $108.88
| Professional | | $29.35 | $77.00 | $108.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.37 / $60.88 / $144.28
| Professional | | $28.37 | $60.88 | $144.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.83 / $81.43 / $124.96
| Facility | | $32.83 | $81.43 | $124.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.41 / $100.72 / $136.88
| Professional | | $78.41 | $100.72 | $136.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.46 / $79.09 / $101.77
| Professional | | $32.46 | $79.09 | $101.77 |