- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.72 / $65.94 / $82.52
| Professional | | $50.72 | $65.94 | $82.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.20 / $119.06 / $119.06
| Professional | | $101.20 | $119.06 | $119.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.36 / $130.84 / $163.55
| Professional | | $81.36 | $130.84 | $163.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.34 / $74.94 / $354.23
| Facility | | $56.34 | $74.94 | $354.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.80 / $82.15 / $118.62
| Professional | | $67.80 | $82.15 | $118.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.80 / $82.66 / $110.97
| Professional | | $67.80 | $82.66 | $110.97 |