- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.47 / $109.29 / $302.47
| Professional | | $90.47 | $109.29 | $302.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.02 / $189.42 / $975.20
| Professional | | $104.02 | $189.42 | $975.20 |
- 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 / $140.55 / $258.55
| Professional | | $101.43 | $140.55 | $258.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.47 / $120.44 / $224.01
| Facility | | $90.47 | $120.44 | $224.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.47 / $130.34 / $1,082.00
| Professional | | $104.47 | $130.34 | $1,082.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.90 / $121.68 / $218.15
| Professional | | $102.90 | $121.68 | $218.15 |