- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.37 / $165.46 / $326.00
| Professional | | $103.37 | $165.46 | $326.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.23 / $179.58 / $240.59
| Professional | | $116.23 | $179.58 | $240.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.60 / $158.62 / $203.33
| Facility | | $109.60 | $158.62 | $203.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.07 / $199.71 / $221.90
| Professional | | $183.07 | $199.71 | $221.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $184.75
| Professional | | $32.34 | $32.34 | $184.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.88 / $171.64 / $213.57
| Professional | | $145.88 | $171.64 | $213.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.91 / $165.62 / $209.23
| Professional | | $126.91 | $165.62 | $209.23 |