- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.07 / $113.85 / $140.47
| Professional | | $102.07 | $113.85 | $140.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.36 / $114.55 / $197.11
| Professional | | $97.36 | $114.55 | $197.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.42 / $95.42 / $95.42
| Facility | | $95.42 | $95.42 | $95.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.38 / $134.71 / $228.88
| Professional | | $81.38 | $134.71 | $228.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.53 / $128.61 / $212.54
| Professional | | $115.53 | $128.61 | $212.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.14 / $113.85 / $197.12
| Professional | | $105.14 | $113.85 | $197.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.95 / $154.37 / $199.61
| Professional | | $93.95 | $154.37 | $199.61 |