- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.01 / $155.30 / $595.21
| Professional | | $103.01 | $155.30 | $595.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.47 / $207.68 / $315.06
| Professional | | $109.47 | $207.68 | $315.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.87 / $342.47 / $396.24
| Professional | | $250.87 | $342.47 | $396.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.70 / $346.95 / $1,244.64
| Professional | | $186.70 | $346.95 | $1,244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.40 / $301.45 / $406.00
| Professional | | $220.40 | $301.45 | $406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $217.90 / $445.30
| Professional | | $3.00 | $217.90 | $445.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.02 / $329.61 / $392.91
| Professional | | $198.02 | $329.61 | $392.91 |