- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.39 / $45.60 / $58.21
| Professional | | $40.39 | $45.60 | $58.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.38 / $200.17 / $244.64
| Facility | | $153.38 | $200.17 | $244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.83 / $76.83 / $76.83
| Professional | | $76.83 | $76.83 | $76.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.50 / $229.42 / $234.01
| Facility | | $130.50 | $229.42 | $234.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.16 / $68.73 / $109.83
| Professional | | $28.16 | $68.73 | $109.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.80 / $47.60 / $113.81
| Professional | | $23.80 | $47.60 | $113.81 |