- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.15 / $24.08 / $33.82
| Professional | | $22.15 | $24.08 | $33.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.00 / $1,093.00 / $1,093.00
| Professional | | $1,093.00 | $1,093.00 | $1,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.82 / $137.82 / $137.82
| Facility | | $137.82 | $137.82 | $137.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.40 / $51.92 / $102.82
| Professional | | $38.40 | $51.92 | $102.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.11 / $75.73 / $90.17
| Professional | | $60.11 | $75.73 | $90.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $29.74 / $56.90
| Professional | | $20.00 | $29.74 | $56.90 |