- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.67 / $142.66 / $686.00
| Professional | | $119.67 | $142.66 | $686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.00 / $148.36 / $215.61
| Professional | | $134.00 | $148.36 | $215.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.07 / $181.56 / $251.85
| Professional | | $126.07 | $181.56 | $251.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $161.69 / $243.32
| Professional | | $2.56 | $161.69 | $243.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.74 / $148.26 / $240.62
| Professional | | $1.74 | $148.26 | $240.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.29 / $177.37 / $277.83
| Professional | | $135.29 | $177.37 | $277.83 |