- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.92 / $173.87 / $1,031.15
| Professional | | $106.92 | $173.87 | $1,031.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.80 / $23.18 / $23.18
| Professional | | $20.80 | $23.18 | $23.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.96 / $160.96 / $267.55
| Facility | | $160.96 | $160.96 | $267.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.82 / $160.96 / $274.23
| Professional | | $136.82 | $160.96 | $274.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.87 / $260.87 / $1,154.28
| Facility | | $110.87 | $260.87 | $1,154.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.96 / $181.08 / $258.69
| Professional | | $104.96 | $181.08 | $258.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.96 / $166.87 / $246.37
| Professional | | $104.96 | $166.87 | $246.37 |