- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.13 / $103.28 / $121.51
| Professional | | $75.13 | $103.28 | $121.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.43 / $94.43 / $106.23
| Professional | | $94.43 | $94.43 | $106.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.62 / $85.61 / $121.51
| Facility | | $55.62 | $85.61 | $121.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.22 / $129.62 / $140.72
| Professional | | $122.22 | $129.62 | $140.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.56 / $70.56 / $70.56
| Professional | | $70.56 | $70.56 | $70.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.43 / $133.40 / $133.40
| Professional | | $113.43 | $133.40 | $133.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.00 / $95.00 / $130.35
| Professional | | $82.00 | $95.00 | $130.35 |