- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.33 / $135.49 / $154.16
| Professional | | $122.33 | $135.49 | $154.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.61 / $75.61 / $115.97
| Professional | | $75.61 | $75.61 | $115.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.06 / $228.88 / $246.48
| Facility | | $176.06 | $228.88 | $246.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.06 / $193.67 / $220.08
| Professional | | $176.06 | $193.67 | $220.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.51 / $84.51 / $204.00
| Professional | | $84.51 | $84.51 | $204.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.56 / $83.59 / $110.36
| Professional | | $58.56 | $83.59 | $110.36 |