- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $190.55 / $316.23
| Professional | | $141.25 | $190.55 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $251.19 / $263.03
| Professional | | $213.80 | $251.19 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $204.17 / $245.47
| Professional | | $154.88 | $204.17 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $199.53 / $263.03
| Professional | | $125.89 | $199.53 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $263.03 / $275.42
| Professional | | $177.83 | $263.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $234.42 / $1,000.00
| Professional | | $104.71 | $234.42 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $186.21 / $275.42
| Professional | | $131.83 | $186.21 | $275.42 |