- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.66 / $53.81 / $64.14
| Professional | | $47.66 | $53.81 | $64.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.16 / $291.85 / $340.01
| Facility | | $183.16 | $291.85 | $340.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.22 / $55.67 / $55.67
| Professional | | $40.22 | $55.67 | $55.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.31 / $50.31 / $50.44
| Professional | | $50.31 | $50.31 | $50.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.47 / $72.73 / $115.62
| Professional | | $54.47 | $72.73 | $115.62 |