- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.03 / $52.61 / $88.52
| Professional | | $35.03 | $52.61 | $88.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.34 / $124.30 / $207.13
| Professional | | $82.34 | $124.30 | $207.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.00 / $55.00 / $61.00
| Professional | | $54.00 | $55.00 | $61.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.70 / $62.90 / $244.00
| Professional | | $37.70 | $62.90 | $244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.00 / $90.00 / $176.00
| Facility | | $90.00 | $90.00 | $176.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.00 / $206.00 / $206.00
| Professional | | $132.00 | $206.00 | $206.00 |