- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.22 / $107.04 / $124.59
| Professional | | $100.22 | $107.04 | $124.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.72 / $38.72 / $114.17
| Professional | | $38.72 | $38.72 | $114.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.71 / $101.01 / $165.32
| Facility | | $53.71 | $101.01 | $165.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.76 / $92.46 / $153.08
| Professional | | $44.76 | $92.46 | $153.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.50 / $143.50 / $143.50
| Facility | | $143.50 | $143.50 | $143.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.00 / $123.62 / $226.92
| Professional | | $36.00 | $123.62 | $226.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.55 / $116.42 / $231.30
| Professional | | $71.55 | $116.42 | $231.30 |