- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.51 / $158.27 / $254.27
| Professional | | $130.51 | $158.27 | $254.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.41 / $239.68 / $406.56
| Professional | | $159.41 | $239.68 | $406.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.88 / $150.88 / $323.91
| Professional | | $150.88 | $150.88 | $323.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.59 / $286.11 / $850.00
| Professional | | $163.59 | $286.11 | $850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.78 / $260.33 / $302.64
| Professional | | $223.78 | $260.33 | $302.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.43 / $217.94 / $433.72
| Professional | | $132.43 | $217.94 | $433.72 |