- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $109.65 / $112.20
| Professional | | $83.18 | $109.65 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $40.74
| Professional | | $32.36 | $32.36 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $169.82
| Facility | | $36.31 | $36.31 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $13.49 / $40.74
| Professional | | $10.72 | $13.49 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $14.45 / $35.48
| Professional | | $10.23 | $14.45 | $35.48 |