- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.53 / $157.29 / $336.49
| Professional | | $131.53 | $157.29 | $336.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.91 / $343.16 / $1,419.28
| Professional | | $154.91 | $343.16 | $1,419.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.59 / $348.74 / $636.62
| Professional | | $222.59 | $348.74 | $636.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.05 / $344.23 / $624.00
| Professional | | $190.05 | $344.23 | $624.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.50 / $227.49 / $358.93
| Professional | | $124.50 | $227.49 | $358.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.83 / $396.77 / $560.64
| Professional | | $186.83 | $396.77 | $560.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.00 / $596.00 / $596.00
| Professional | | $596.00 | $596.00 | $596.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.06 / $459.55 / $1,419.28
| Professional | | $204.06 | $459.55 | $1,419.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.33 / $263.39 / $602.29
| Professional | | $194.33 | $263.39 | $602.29 |