- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.03 / $101.55 / $135.63
| Professional | | $82.03 | $101.55 | $135.63 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $100.38 / $100.38 / $148.08
| Professional | 50 | $100.38 | $100.38 | $148.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.36 / $92.37 / $101.75
| Professional | | $87.36 | $92.37 | $101.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.19 / $106.33 / $196.14
| Professional | | $74.19 | $106.33 | $196.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.90 / $112.46 / $158.84
| Professional | | $92.90 | $112.46 | $158.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.00 / $89.00 / $89.00
| Facility | | $89.00 | $89.00 | $89.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.86 / $101.08 / $177.52
| Professional | | $80.86 | $101.08 | $177.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.76 / $87.77 / $112.46
| Professional | | $80.76 | $87.77 | $112.46 |