- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $247.40 / $256.27
| Professional | | $243.71 | $247.40 | $256.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.26 / $35.75 / $35.75
| Facility | | $32.26 | $35.75 | $35.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.20 / $357.47 / $357.47
| Professional | | $261.20 | $357.47 | $357.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.83 / $170.83 / $170.83
| Facility | | $170.83 | $170.83 | $170.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.21 / $145.21 / $170.83
| Professional | | $145.21 | $145.21 | $170.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.00 / $434.00 / $801.00
| Professional | | $263.00 | $434.00 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.00 / $90.00 / $100.00
| Facility | | $65.00 | $90.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.83 / $247.40 / $258.39
| Facility | | $170.83 | $247.40 | $258.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.21 / $170.83 / $175.95
| Professional | | $145.21 | $170.83 | $175.95 |