- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.59 / $102.07 / $141.94
| Professional | | $87.59 | $102.07 | $141.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.33 / $95.92 / $107.91
| Professional | | $80.33 | $95.92 | $107.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.43 / $139.51 / $258.55
| Professional | | $101.43 | $139.51 | $258.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.47 / $119.63 / $224.01
| Facility | | $90.47 | $119.63 | $224.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.70 / $129.41 / $1,082.00
| Professional | | $104.70 | $129.41 | $1,082.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.68 / $121.68 / $223.68
| Professional | | $103.68 | $121.68 | $223.68 |