- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $42.66 / $117.49
| Professional | | $36.31 | $42.66 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $177.83
| Facility | | $109.65 | $151.36 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $42.66 / $81.28
| Professional | | $31.62 | $42.66 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $48.98
| Facility | | $43.65 | $43.65 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $48.98
| Professional | | $35.48 | $35.48 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $46.77 / $102.33
| Facility | | $37.15 | $46.77 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $43.65 / $63.10
| Professional | | $34.67 | $43.65 | $63.10 |