- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.72 / $83.01 / $94.71
| Professional | | $56.72 | $83.01 | $94.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.42 / $106.42 / $106.42
| Professional | | $106.42 | $106.42 | $106.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.32 / $44.32 / $44.32
| Professional | | $44.32 | $44.32 | $44.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.20 / $91.52 / $139.75
| Facility | | $81.20 | $91.52 | $139.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.71 / $57.94 / $123.04
| Professional | | $30.71 | $57.94 | $123.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.71 / $42.77 / $66.08
| Professional | | $30.71 | $42.77 | $66.08 |