- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.13 / $48.89 / $58.58
| Professional | | $46.13 | $48.89 | $58.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.65 / $208.65 / $208.65
| Facility | | $208.65 | $208.65 | $208.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.33 / $201.25 / $201.25
| Professional | | $54.33 | $201.25 | $201.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.33 / $62.60 / $100.57
| Facility | | $54.33 | $62.60 | $100.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.33 / $60.53 / $72.81
| Professional | | $54.33 | $60.53 | $72.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.59 / $64.59 / $64.59
| Professional | | $64.59 | $64.59 | $64.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.18 / $45.45 / $54.09
| Professional | | $43.18 | $45.45 | $54.09 |