- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $81.28 / $316.23
| Professional | | $60.26 | $81.28 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $208.93 / $208.93
| Professional | | $186.21 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $125.89
| Professional | | $100.00 | $100.00 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $64.57 / $91.20
| Facility | | $51.29 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $190.55 / $1,174.90
| Professional | | $181.97 | $190.55 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $165.96 / $213.80
| Professional | | $89.13 | $165.96 | $213.80 |