- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.15 / $45.46 / $54.35
| Professional | | $38.15 | $45.46 | $54.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.96 / $138.00 / $166.10
| Facility | | $94.96 | $138.00 | $166.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.23 / $52.73 / $75.33
| Professional | | $41.23 | $52.73 | $75.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.51 / $64.28 / $101.92
| Professional | | $51.51 | $64.28 | $101.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.61 / $66.78 / $84.98
| Professional | | $51.61 | $66.78 | $84.98 |