- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $130.09 / $612.00
| Professional | | $106.17 | $130.09 | $612.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.68 / $128.15 / $245.79
| Professional | | $97.68 | $128.15 | $245.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.08 / $171.29 / $218.01
| Professional | | $127.08 | $171.29 | $218.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $217.65
| Professional | | $32.34 | $32.34 | $217.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.08 / $171.29 / $218.01
| Professional | | $127.08 | $171.29 | $218.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.43 / $158.34 / $247.01
| Professional | | $147.43 | $158.34 | $247.01 |