- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.32 / $110.83 / $154.97
| Professional | | $100.32 | $110.83 | $154.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,478.00 / $1,478.00 / $1,863.00
| Facility | | $1,478.00 | $1,478.00 | $1,863.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.34 / $156.97 / $203.73
| Professional | | $101.34 | $156.97 | $203.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.68 / $155.34 / $213.86
| Facility | | $121.68 | $155.34 | $213.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.24 / $172.08 / $196.66
| Professional | | $162.24 | $172.08 | $196.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $145.22 / $182.70
| Professional | | $32.34 | $145.22 | $182.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $141.18 / $169.45
| Professional | | $120.00 | $141.18 | $169.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.70 / $144.44 / $192.14
| Professional | | $103.70 | $144.44 | $192.14 |