- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.32 / $53.43 / $65.73
| Professional | | $45.32 | $53.43 | $65.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.91 / $40.27 / $64.94
| Professional | | $28.91 | $40.27 | $64.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.44 / $32.19 / $32.19
| Professional | | $31.44 | $32.19 | $32.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.94 / $67.76 / $133.25
| Facility | | $49.94 | $67.76 | $133.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.63 / $34.90 / $106.63
| Professional | | $26.63 | $34.90 | $106.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.20 / $33.46 / $51.73
| Professional | | $26.20 | $33.46 | $51.73 |