- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.62 / $147.06 / $254.45
| Professional | | $123.62 | $147.06 | $254.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.43 / $227.81 / $387.00
| Professional | | $154.43 | $227.81 | $387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.77 / $209.86 / $378.28
| Professional | | $151.77 | $209.86 | $378.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.91 / $194.00 / $400.00
| Professional | | $186.91 | $194.00 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.96 / $218.68 / $270.70
| Professional | | $182.96 | $218.68 | $270.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $183.75 / $373.33
| Professional | | $129.63 | $183.75 | $373.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.72 / $1,120.40 / $1,275.98
| Professional | | $936.72 | $1,120.40 | $1,275.98 |