- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.50 / $64.50 / $81.06
| Professional | | $53.50 | $64.50 | $81.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.06 / $105.06 / $105.06
| Professional | | $105.06 | $105.06 | $105.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.76 / $69.38 / $113.41
| Professional | | $46.76 | $69.38 | $113.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.96 / $67.83 / $104.46
| Facility | | $54.96 | $67.83 | $104.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.69 / $80.86 / $126.15
| Professional | | $64.69 | $80.86 | $126.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.25 / $67.14 / $102.32
| Professional | | $51.25 | $67.14 | $102.32 |