- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $177.83 / $229.09
| Professional | | $151.36 | $177.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $309.03
| Professional | | $154.88 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $190.55 / $204.17
| Professional | | $173.78 | $190.55 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $389.05
| Professional | | $151.36 | $208.93 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $239.88
| Professional | | $162.18 | $199.53 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $10,000.00
| Professional | | $162.18 | $245.47 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $190.55 / $338.84
| Professional | | $134.90 | $190.55 | $338.84 |