- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.21 / $85.77 / $95.89
| Professional | | $52.21 | $85.77 | $95.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.02 / $106.02 / $106.02
| Facility | | $106.02 | $106.02 | $106.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.72 / $111.32 / $143.13
| Professional | | $100.72 | $111.32 | $143.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.54 / $50.89 / $153.75
| Professional | | $34.54 | $50.89 | $153.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.92 / $85.77 / $102.53
| Professional | | $63.92 | $85.77 | $102.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $14.50 / $22.69
| Professional | | $12.61 | $14.50 | $22.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.41 / $49.79 / $70.84
| Professional | | $41.41 | $49.79 | $70.84 |