- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.51 / $213.76 / $343.15
| Professional | | $168.51 | $213.76 | $343.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.13 / $311.58 / $336.90
| Professional | | $216.13 | $311.58 | $336.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.70 / $260.00 / $408.31
| Professional | | $177.70 | $260.00 | $408.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.78 / $302.95 / $700.85
| Professional | | $194.78 | $302.95 | $700.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.04 / $226.34 / $248.38
| Professional | | $224.04 | $226.34 | $248.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $286.58
| Professional | | $32.34 | $32.34 | $286.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.59 / $272.75 / $407.78
| Professional | | $195.59 | $272.75 | $407.78 |