- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $83.18 / $85.11
| Professional | | $63.10 | $83.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $46.77
| Professional | | $37.15 | $37.15 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $112.20
| Facility | | $36.31 | $36.31 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $12.59 / $40.74
| Professional | | $10.23 | $12.59 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $14.45 / $35.48
| Professional | | $10.00 | $14.45 | $35.48 |