- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.61 / $47.81 / $48.26
| Professional | | $38.61 | $47.81 | $48.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.01 / $40.94 / $118.62
| Facility | | $24.01 | $40.94 | $118.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.68 / $217.25 / $217.25
| Professional | | $53.68 | $217.25 | $217.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.00 / $61.62 / $61.62
| Facility | | $39.00 | $61.62 | $61.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.07 / $56.23 / $92.67
| Professional | | $46.07 | $56.23 | $92.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.48 / $58.57 / $79.64
| Professional | | $45.48 | $58.57 | $79.64 |