- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.19 / $153.00 / $258.98
| Professional | | $106.19 | $153.00 | $258.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.19 / $152.65 / $348.25
| Professional | | $120.19 | $152.65 | $348.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.62 / $155.62 / $219.12
| Professional | | $155.62 | $155.62 | $219.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.72 / $199.95 / $505.18
| Professional | | $115.72 | $199.95 | $505.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.59 / $239.41 / $352.32
| Professional | | $170.59 | $239.41 | $352.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $159.84 / $331.73
| Professional | | $120.72 | $159.84 | $331.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.97 / $212.93 / $497.05
| Professional | | $124.97 | $212.93 | $497.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.12 / $195.23 / $486.65
| Professional | | $139.12 | $195.23 | $486.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $204.16 / $331.73
| Professional | | $120.72 | $204.16 | $331.73 |