- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.57 / $100.37 / $106.78
| Professional | | $44.57 | $100.37 | $106.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.06 / $81.48 / $97.42
| Professional | | $73.06 | $81.48 | $97.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.82 / $46.82 / $46.82
| Professional | | $46.82 | $46.82 | $46.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.09 / $119.09 / $198.78
| Professional | | $119.09 | $119.09 | $198.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.76 / $91.55 / $103.66
| Facility | | $81.76 | $91.55 | $103.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.82 / $46.82 / $113.89
| Professional | | $46.82 | $46.82 | $113.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $48.67 / $73.31
| Professional | | $45.00 | $48.67 | $73.31 |