- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.07 / $128.34 / $151.60
| Professional | | $115.07 | $128.34 | $151.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.52 / $161.00 / $241.50
| Professional | | $147.52 | $161.00 | $241.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.77 / $103.58 / $560.41
| Professional | | $74.77 | $103.58 | $560.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.07 / $268.00 / $320.00
| Facility | | $115.07 | $268.00 | $320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.14 / $81.14 / $81.14
| Professional | | $81.14 | $81.14 | $81.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.51 / $129.22 / $401.93
| Professional | | $88.51 | $129.22 | $401.93 |