- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.21 / $48.04 / $54.58
| Professional | | $40.21 | $48.04 | $54.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.12 / $175.75 / $208.07
| Facility | | $130.12 | $175.75 | $208.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.09 / $60.11 / $83.23
| Professional | | $51.09 | $60.11 | $83.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.74 / $51.74 / $53.23
| Facility | | $51.74 | $51.74 | $53.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.77 / $37.77 / $37.77
| Professional | | $37.77 | $37.77 | $37.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.90 / $53.21 / $76.53
| Professional | | $39.90 | $53.21 | $76.53 |