- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.29 / $86.04 / $105.04
| Professional | | $80.29 | $86.04 | $105.04 |
- 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
- $88.27 / $129.62 / $165.33
| Professional | | $88.27 | $129.62 | $165.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $136.02
| Professional | | $32.34 | $32.34 | $136.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.83 / $105.04 / $194.85
| Facility | | $80.83 | $105.04 | $194.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.57 / $144.97 / $233.61
| Professional | | $98.57 | $144.97 | $233.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.16 / $125.45 / $180.16
| Professional | | $88.16 | $125.45 | $180.16 |