- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.06 / $274.66 / $428.70
| Professional | | $156.06 | $274.66 | $428.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.71 / $35.71 / $35.71
| Professional | | $35.71 | $35.71 | $35.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.53 / $331.53 / $542.03
| Facility | | $331.53 | $331.53 | $542.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.80 / $331.53 / $552.00
| Professional | | $281.80 | $331.53 | $552.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.85 / $47.61 / $71.42
| Professional | | $42.85 | $47.61 | $71.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.88 / $405.88 / $405.88
| Professional | | $405.88 | $405.88 | $405.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.41 / $266.26 / $488.15
| Professional | | $198.41 | $266.26 | $488.15 |