- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $363.08 / $933.25
| Professional | | $190.55 | $363.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $512.86 / $3,981.07
| Professional | | $245.47 | $512.86 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $489.78 / $1,000.00
| Professional | | $239.88 | $489.78 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $758.58
| Professional | | $416.87 | $537.03 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $457.09 / $954.99
| Professional | | $234.42 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $3,981.07
| Professional | | $251.19 | $512.86 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $457.09 / $891.25
| Professional | | $234.42 | $457.09 | $891.25 |