- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $100.00 / $151.36
| Professional | | $66.07 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $97.72 / $97.72
| Professional | | $83.18 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $107.15 / $162.18
| Professional | | $95.50 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $154.88
| Professional | | $131.83 | $131.83 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $66.07 / $120.23
| Facility | | $7.24 | $66.07 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $93.33 / $154.88
| Professional | | $63.10 | $93.33 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $131.83 / $131.83
| Facility | | $128.82 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $154.88
| Professional | | $131.83 | $131.83 | $154.88 |