- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.36 / $358.26 / $513.54
| Professional | | $256.36 | $358.26 | $513.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.56 / $264.56 / $271.02
| Professional | | $264.56 | $264.56 | $271.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.74 / $31.74 / $50.22
| Professional | | $31.74 | $31.74 | $50.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Facility | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.14 / $330.77 / $506.25
| Professional | | $281.14 | $330.77 | $506.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.66 / $100.00 / $200.00
| Professional | | $60.66 | $100.00 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.61 / $63.48 / $735.58
| Professional | | $47.61 | $63.48 | $735.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.14 / $291.51 / $541.54
| Professional | | $227.14 | $291.51 | $541.54 |