- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.74 / $44.65 / $69.61
| Professional | | $31.74 | $44.65 | $69.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.91 / $206.55 / $244.53
| Facility | | $152.91 | $206.55 | $244.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.83 / $56.83 / $95.07
| Professional | | $56.83 | $56.83 | $95.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.13 / $44.13 / $44.13
| Professional | | $44.13 | $44.13 | $44.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.97 / $61.77 / $89.93
| Professional | | $35.97 | $61.77 | $89.93 |