- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.82 / $52.62 / $56.78
| Professional | | $41.82 | $52.62 | $56.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.34 / $182.79 / $216.41
| Facility | | $135.34 | $182.79 | $216.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.82 / $53.90 / $86.56
| Professional | | $45.82 | $53.90 | $86.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.48 / $70.48 / $70.48
| Facility | | $70.48 | $70.48 | $70.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.45 / $70.48 / $70.48
| Professional | | $51.45 | $70.48 | $70.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.39 / $51.00 / $79.59
| Professional | | $37.39 | $51.00 | $79.59 |