- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.50 / $129.81 / $230.00
| Professional | | $80.50 | $129.81 | $230.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.56 / $71.56 / $206.14
| Professional | | $71.56 | $71.56 | $206.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.48 / $100.45 / $186.02
| Facility | | $94.48 | $100.45 | $186.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.55 / $113.65 / $209.80
| Professional | | $94.55 | $113.65 | $209.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.12 / $43.41 / $143.75
| Professional | | $1.12 | $43.41 | $143.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.25 / $103.39 / $230.00
| Professional | | $86.25 | $103.39 | $230.00 |