- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $354.81 / $562.34
| Facility | | $151.36 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $102.33 / $309.03
| Professional | | $81.28 | $102.33 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $144.54 / $154.88
| Facility | | $64.57 | $144.54 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $93.33 / $100.00
| Professional | | $70.79 | $93.33 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $389.05
| Facility | | $218.78 | $346.74 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $74.13 / $194.98
| Professional | | $60.26 | $74.13 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $74.13 / $181.97
| Professional | | $52.48 | $74.13 | $181.97 |