- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $158.49 / $380.19
| Professional | | $131.83 | $158.49 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $363.08 / $537.03
| Facility | | $112.20 | $363.08 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $131.83 / $257.04
| Professional | | $104.71 | $131.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $141.25 / $269.15
| Professional | | $100.00 | $141.25 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $234.42
| Facility | | $85.11 | $144.54 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $138.04 / $977.24
| Professional | | $104.71 | $138.04 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $128.82 / $186.21
| Professional | | $100.00 | $128.82 | $186.21 |