- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.51 / $31.76 / $38.92
| Professional | | $26.51 | $31.76 | $38.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.76 / $47.98 / $63.93
| Professional | | $40.76 | $47.98 | $63.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.65 / $48.17 / $56.31
| Professional | | $37.65 | $48.17 | $56.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.50 / $47.27 / $214.62
| Facility | | $35.50 | $47.27 | $214.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.29 / $57.71 / $94.51
| Professional | | $46.29 | $57.71 | $94.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.62 / $58.69 / $74.91
| Professional | | $46.62 | $58.69 | $74.91 |