- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.37 / $159.54 / $196.18
| Professional | | $130.37 | $159.54 | $196.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.80 / $551.85 / $966.98
| Facility | | $147.80 | $551.85 | $966.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.24 / $116.63 / $145.03
| Professional | | $82.24 | $116.63 | $145.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $141.06 / $141.06
| Professional | | $141.06 | $141.06 | $141.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.37 / $154.63 / $300.83
| Facility | | $130.37 | $154.63 | $300.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.19 / $202.39 / $1,105.55
| Professional | | $161.19 | $202.39 | $1,105.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.41 / $187.20 / $344.15
| Professional | | $158.41 | $187.20 | $344.15 |