- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $144.54 / $186.21
| Facility | | $107.15 | $144.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $117.49 / $213.80
| Professional | | $100.00 | $117.49 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $223.87 / $501.19
| Facility | | $199.53 | $223.87 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $275.42 / $354.81
| Professional | | $114.82 | $275.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $741.31 / $812.83
| Facility | | $288.40 | $741.31 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $154.88 / $501.19
| Professional | | $112.20 | $154.88 | $501.19 |