- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.30 / $86.87 / $105.04
| Professional | | $80.30 | $86.87 | $105.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.50 / $101.66 / $161.12
| Professional | | $80.50 | $101.66 | $161.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.08 / $97.30 / $113.51
| Facility | | $81.08 | $97.30 | $113.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.08 / $97.30 / $117.57
| Professional | | $81.08 | $97.30 | $117.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.28 / $100.28 / $100.28
| Facility | | $100.28 | $100.28 | $100.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.24 / $120.97 / $192.57
| Professional | | $86.24 | $120.97 | $192.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.68 / $93.65 / $136.08
| Professional | | $76.68 | $93.65 | $136.08 |