- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.31 / $185.48 / $508.12
| Professional | | $140.31 | $185.48 | $508.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.84 / $208.33 / $263.61
| Professional | | $143.84 | $208.33 | $263.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.74 / $216.76 / $234.90
| Professional | | $193.74 | $216.76 | $234.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $165.11 / $186.41
| Professional | | $32.34 | $165.11 | $186.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.54 / $190.05 / $220.86
| Professional | | $161.54 | $190.05 | $220.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.68 / $194.88 / $255.77
| Professional | | $149.68 | $194.88 | $255.77 |