- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.34 / $102.10 / $102.36
| Professional | | $70.34 | $102.10 | $102.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.08 / $96.39 / $112.46
| Professional | | $50.08 | $96.39 | $112.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.60 / $102.10 / $131.02
| Facility | | $60.60 | $102.10 | $131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.69 / $129.06 / $147.50
| Professional | | $121.69 | $129.06 | $147.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $117.20
| Professional | | $30.00 | $30.00 | $117.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.27 / $115.42 / $132.22
| Professional | | $109.27 | $115.42 | $132.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $53.91 / $102.08
| Professional | | $36.26 | $53.91 | $102.08 |