- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.53 / $123.24 / $248.86
| Professional | | $100.53 | $123.24 | $248.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.55 / $134.55 / $134.55
| Professional | | $134.55 | $134.55 | $134.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.16 / $136.50 / $185.29
| Professional | | $125.16 | $136.50 | $185.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.67 / $90.16 / $277.77
| Professional | | $58.67 | $90.16 | $277.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.53 / $151.38 / $310.00
| Facility | | $100.53 | $151.38 | $310.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.68 / $156.94 / $235.41
| Professional | | $132.68 | $156.94 | $235.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.15 / $122.80 / $431.54
| Professional | | $89.15 | $122.80 | $431.54 |