- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $49.53 / $72.38
| Professional | | $32.15 | $49.53 | $72.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.03 / $240.32 / $323.31
| Facility | | $198.03 | $240.32 | $323.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.79 / $43.48 / $51.31
| Professional | | $35.79 | $43.48 | $51.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.31 / $50.31 / $73.54
| Professional | | $50.31 | $50.31 | $73.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.93 / $59.44 / $82.55
| Professional | | $42.93 | $59.44 | $82.55 |