- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.61 / $48.07 / $49.03
| Professional | | $38.61 | $48.07 | $49.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.02 / $64.23 / $118.62
| Facility | | $36.02 | $64.23 | $118.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.40 / $78.45 / $217.25
| Professional | | $48.40 | $78.45 | $217.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.00 / $56.23 / $61.62
| Facility | | $39.00 | $56.23 | $61.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.07 / $56.23 / $94.88
| Professional | | $46.07 | $56.23 | $94.88 |