- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $100.00 / $234.42
| Professional | | $70.79 | $100.00 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $107.15 / $288.40
| Professional | | $56.23 | $107.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $141.25 / $229.09
| Professional | | $138.04 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $117.49 / $223.87
| Professional | | $63.10 | $117.49 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,232.93 / $10,232.93
| Facility | | $5,370.32 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $91.20 / $181.97
| Professional | | $51.29 | $91.20 | $181.97 |