- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.94 / $209.04 / $326.20
| Professional | | $175.94 | $209.04 | $326.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $294.52 / $671.71
| Professional | | $32.61 | $294.52 | $671.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.54 / $35.56 / $378.68
| Facility | | $35.54 | $35.56 | $378.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.54 / $35.54 / $35.56
| Professional | | $35.54 | $35.54 | $35.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.34 / $240.34 / $298.26
| Facility | | $240.34 | $240.34 | $298.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.42 / $240.34 / $483.75
| Professional | | $33.42 | $240.34 | $483.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.72 / $448.51 / $1,022.00
| Professional | | $43.72 | $448.51 | $1,022.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.72 / $218.70 / $399.21
| Professional | | $138.72 | $218.70 | $399.21 |