- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $1,000.00
| Professional | | $147.91 | $234.42 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $457.09
| Professional | | $158.49 | $251.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $323.59
| Professional | | $32.36 | $33.11 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $512.86
| Professional | | $218.78 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $309.03 / $446.68
| Professional | | $181.97 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $489.78
| Professional | | $208.93 | $309.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $316.23
| Professional | | $147.91 | $208.93 | $316.23 |