- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.12 / $63.70 / $77.06
| Professional | | $58.12 | $63.70 | $77.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.93 / $35.93 / $57.98
| Professional | | $35.93 | $35.93 | $57.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.65 / $108.75 / $117.11
| Facility | | $83.65 | $108.75 | $117.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.65 / $92.02 / $104.56
| Professional | | $83.65 | $92.02 | $104.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.71 / $38.71 / $97.13
| Professional | | $38.71 | $38.71 | $97.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.82 / $39.69 / $53.45
| Professional | | $26.82 | $39.69 | $53.45 |