- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $144.54 / $302.00
| Professional | | $97.72 | $144.54 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $134.90 / $354.81
| Professional | | $109.65 | $134.90 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $199.53
| Professional | | $151.36 | $151.36 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $194.98 / $512.86
| Professional | | $117.49 | $194.98 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $354.81
| Professional | | $177.83 | $245.47 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $190.55 / $302.00
| Professional | | $114.82 | $190.55 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $501.19
| Professional | | $165.96 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $151.36 / $380.19
| Professional | | $97.72 | $151.36 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $173.78 / $371.54
| Professional | | $117.49 | $173.78 | $371.54 |