- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.19 / $190.43 / $235.67
| Professional | | $157.19 | $190.43 | $235.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.04 / $367.10 / $519.15
| Professional | | $250.04 | $367.10 | $519.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.28 / $446.68 / $1,402.08
| Facility | | $245.28 | $446.68 | $1,402.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.58 / $168.18 / $245.38
| Professional | | $104.58 | $168.18 | $245.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.35 / $160.22 / $297.62
| Professional | | $90.35 | $160.22 | $297.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.60 / $330.00 / $580.01
| Professional | | $97.60 | $330.00 | $580.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.03 / $84.73 / $107.84
| Professional | | $77.03 | $84.73 | $107.84 |