- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.11 / $123.38 / $134.91
| Professional | | $110.11 | $123.38 | $134.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.65 / $151.53 / $214.34
| Professional | | $118.65 | $151.53 | $214.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.31 / $117.31 / $456.00
| Facility | | $117.31 | $117.31 | $456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.01 / $160.00 / $238.36
| Professional | | $100.01 | $160.00 | $238.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.27 / $149.75 / $234.33
| Professional | | $116.27 | $149.75 | $234.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.11 / $123.38 / $242.98
| Professional | | $110.11 | $123.38 | $242.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.53 / $150.80 / $229.73
| Professional | | $100.53 | $150.80 | $229.73 |