- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.54 / $64.37 / $78.83
| Professional | | $49.54 | $64.37 | $78.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.12 / $95.16 / $124.32
| Professional | | $62.12 | $95.16 | $124.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.96 / $81.23 / $127.44
| Professional | | $56.96 | $81.23 | $127.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.78 / $69.33 / $92.13
| Facility | | $52.78 | $69.33 | $92.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.87 / $116.12 / $204.67
| Professional | | $93.87 | $116.12 | $204.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.59 / $93.48 / $171.50
| Professional | | $64.59 | $93.48 | $171.50 |