- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.78 / $82.09 / $82.09
| Professional | | $52.78 | $82.09 | $82.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.92 / $200.17 / $311.81
| Facility | | $190.92 | $200.17 | $311.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.13 / $100.13 / $100.13
| Professional | | $100.13 | $100.13 | $100.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.53 / $170.47 / $305.27
| Facility | | $47.53 | $170.47 | $305.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.15 / $84.25 / $105.32
| Professional | | $36.15 | $84.25 | $105.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.05 / $45.47 / $148.66
| Professional | | $1.05 | $45.47 | $148.66 |