- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.22 / $65.84 / $81.26
| Professional | | $59.22 | $65.84 | $81.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.03 / $111.37 / $133.08
| Facility | | $102.03 | $111.37 | $133.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.81 / $110.76 / $215.20
| Professional | | $92.81 | $110.76 | $215.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.17 / $108.17 / $108.17
| Facility | | $108.17 | $108.17 | $108.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.14 / $36.14 / $36.14
| Professional | | $36.14 | $36.14 | $36.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.81 / $46.30 / $77.51
| Professional | | $38.81 | $46.30 | $77.51 |